Royal Air Force and Dependants

 Disabled Holiday Trust

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Application Form / Questionnaire

Please complete this form and send it to the Trust by clicking the submit button at the bottom of the form. Submission of the form will be taken as confirmation that you will pay your own travel expenses and will provide your own nursing companion or helper, as necessary. However it should be noted that financial assistance with air fares may be available on a means-tested basis.

If you would prefer to mail in your application you may download a pdf version of this form. To view and print it you need to use a PDF file viewer such as Acrobat Reader or Acrobat Exchange from Adobe Systems Incorporated. Click on the button below to download a free version of Adobe Acrobat Reader from Adobe's website.

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Right click HERE and select 'Save target as...' to download form in .pdf format

Title: Mr | Mrs | Miss
Surname:
Initials:
House Name:
Street Address:
Town/Village:
Post Town:
County:
Post Code:
Country:
Telephone No:
Dates of Service - From:
Dates of Service - To:
E mail:
Date of birth:
Service Number:
Rank last held:
Service: Regular | War Service | National Service
War Pensioner: Yes | No
If yes, please state percentage disability awarded: %
Relationship of disabled person to ex-RAF or RAF person (if not the same person):
Please state nature of disability
What effect does this have on mobility?
Does the disabled person use a wheelchair full-time? Yes | No
If not, is a wheelchair used sometimes Yes | No
Holiday Location preferences
(Tick all which apply)		 Rocha Brava, Algarve, Portugal
Constant near Bergerac, Dordogne, France
Le Manoir de Hilguy, Quimper, Brittany
La Reserva de Biniorella, Majorca
Le Mont de St Simeon, France
Tigh Mor Trossachs, Scotland
St Brides Castle, Wales
Langton House, Dorset
Duloe Manor, Cornwall
Sibton Park, Kent
Henllys, Anglesey, Wales
Preferred time of year for holiday Spring
Summer
Autumn
Winter
Could you take a holiday booking at short notice? (2 months) Yes | No
Do you agree to this information being held on computer by the Trust? Yes | No
How did you hear about the Trust?
(Tick all which apply)		 Word of Mouth
RAF on discharge
SSAFA Forces Help
War Pensions Agency
RAFBF
RAFA
Other, please specify in box below.
Additional Information:

 

© 2008 Royal Air Force and Dependants Disabled Holiday Trust.
Registered Charity No. 286019.