Application form

Your request has been received. Please now complete the application form below

If you reserved a property, it will be held for 1 hour whilst you complete this form.

This field is for validation purposes and should be left unchanged.

What type of break are you applying for?(Required)

I have made a reservation via the Property Portal (child under 5)

I have made a Last minute reservation (child over 5)

I have made a reservation for a Carer Only Respite Break

I reserved a property but no longer wish to complete the application. Please cancel my reservation.

Name(Required)

First name Last name

Holiday property name(Required)

If you’re unsure, the name of the property will have been emailed to the address used on the reservation form.

Break reference number(Required)

This field is hidden when viewing the form

Date

Email(Required)

Please enter the same email address that you used to reserve your chosen property.

Enter Email Confirm Email

Phone number(Required)

Address(Required)

Street Address Address Line 2 City Postcode

Child named on qualifying benefit letter (uploaded during reservation process)(Required)

First Last

Age of qualifying child(Required)

Date of Birth(Required)

DLA / PIP / CDP reference number – of letter uploaded in the reservation section(Required)

Date of latest DLA award letter(Required)

Date the higher rate award is valid until(Required)

This should be the date quoted in your letter often stated as ‘higher rate award from dd/mm/yyyy to dd/mm/yyyy’ OR ‘From dd/mm/yyyy to dd/mm/yyyy you are entitled to’.

Have you received a break from Time Away before?(Required)

Time Away only permit one break in any 24 month period. To continue your application ensure that the end date of your previous break was at least 24 months before the start of the break you’re applying for. If you wish to cancel this application please select option 3 at the top of this form.

If you wish to cancel this application please select option 3 at the top of this form.

Approximately how long ago did you last take a holiday (with the child named on this form)(Required)

Declarations

I UNDERSTAND THAT BY MAKING ANY FALSE DECLARATIONS ABOVE, I MAY BE EXCLUDED FROM ACCESSING ANY TIME AWAY BREAKS IN THE FUTURE – I confirm that, the information provided within this application form is accurate and that by submitting it I will commit to book this property for the dates specified. I confirm that I have checked that the property is suitable for our family requirements.(Required)

I agree

I agree to the Terms of use and Privacy policy.(Required)

I agree

View our privacy policy here

View our terms and conditions here

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