Holiday Accommodation - Registration form

Address Details

Name (Required)

Address (Required)

Address Line 2

Town/City (Required)

Post Code (Required)

Website

Email address (Required)

Contact phone number: (Required)

Type of Accommodation

Star rating (Required) 1 2 3 4 5

Sleeps

Please supply approx 5 quality photographic images to promote your business (Max file size 2MB per photo)

Image 1

Image 2

Image 3

Image 4

Image 5

Detailed Info

Accessibility Statement Yes No

Parking Space provided Within 50m of entrance Drop off point

Entrance surface material Gravel Solid surface Cobbles Grass Other

Access to entrance Level Ramp Lift One Step Well lit

Minimum door width (entrance, living area, bedroom, bathroom - Measure your narrowest door (cm))

Level access (no steps or access by ramp or lift) to: Toilet and bathroom One bedroom Two bedrooms Lounge Kitchen Dining room Garden/patio

Good contrast between walls & floors (visually impaired) Yes No

Aids for visually impaired Yes No

Aids for hearing impaired Yes No

Kitchen sink taps have lever handles Yes No

Adjustable height Worksurface Sink

Bedroom has non allergic bedding available Yes No

Bathroom Wetroom Level access shower Bath with shower over Bathboard available Shower with 1 step into unit

Other info

Equipment Electric profiling bed Shower chair Shower chair on wheels Portable Hoist Memory mattress Cot sides Bed raisers Recliner chair

Clear space of at least 150mm under bed for hoist Yes No

Other special equipment

Special services (i.e. oxygen)

Special outdoor/activity equipment

Facilities Facilities for washing/drying laundry Broadband/WI-FI Phone line available TV with subtitles TV with remote control Staff available on site Care agency support available Removable/flexible furniture Adjacent bedroom for carer/companion

Distance available at one side of bed for wheelchair access (cm)

Accessible local public transport nearby Yes No

Wheelchair turning space in bedroom Bedroom - Independent (1200mm x 1200mm) Bedroom - Assisted (1500mm x 1500mm) Bathroom - Independent (1200mm x 1200mm) Bathroom - Assisted user (1500mm x 1500mm) Living Area - Independent (1200mm x 1200mm) Living Area - Assisted (1500mm x 1500mm)

Pre-bookable mobility equipment hire available Yes No

Any other information you wish to include

(Required) required field