Short Breaks Booking Form

Before booking please refer to the costs of our Short breaks services via visiting the Short breaks page here.

To reserve a place on our Short Breaks activities, please complete the form below, uploading the service user’s latest ‘All About Me’ form if you have it. Once we receive your booking, we will be in contact to confirm the places and any additional information required.

 

Please upload the Service User's 'All About Me' form if available:

Is the person completing this form the parent/carer of the service user?

YesNo

Please complete the details of the parent / carer of the service user.

Which activities would you like to book?

You only need to complete this form once; select all of the activities and dates you require.
You can come back at a later stage if you wish to book further dates.

DXACreative ConnectionsM-PowerExpress Breckland

Please select which DXA dates the service user would like to attend between April 2017 - February 2018:

EasterMaySummerOctoberFebruary

Please select which DXA dates the service user would like to attend in Easter 2017:

Monday 3rd April Kings LynnTuesday 4th April NorwichWednesday 5th April StibbardThursday 6th April AttleboroughFriday 7th April Great YarmouthMonday 10th April Norwich

Please select which DXA dates the service user would like to attend in May 2017:

Tuesday 30th May NorwichTuesday 30th May Kings LynnWednesday 31st May NorwichWednesday 31st May StibbardThursday 1st June AttleboroughFriday 2nd June Great Yarmouth

Please select which DXA dates the service user would like to attend in Summer 2017:

Monday 7th August NorwichTuesday 8th August Kings LynnWednesday 9th August StibbardThursday 10th August AttleboroughFriday 11th August NorwichFriday 11th August Great YarmouthFriday 25th August NorwichTuesday 29th August Kings LynnWednesday 30th August StibbardThursday 31st August AttleboroughFriday 1st September NorwichFriday 1st September Great Yarmouth

Please select which DXA dates the service user would like to attend in October 2017:

Monday 23rd October NorwichMonday 23rd October Kings LynnTuesday 24th October NorwichWednesday 25th October StibbardThursday 26th October AttleboroughFriday 27th October Great Yarmouth

Please select which DXA dates the service user would like to attend in February 2018:

Monday 12th February NorwichMonday 12th February Kings LynnTuesday 13th February NorwichWednesday 14th February StibbardThursday 15th February AttleboroughFriday 16th February Great Yarmouth

Please select which Creative Connections dates the service user would like to attend between April 2017 - February 2018:

EasterMaySummerOctoberFebruary

There are no Creative Connections sessions scheduled for Easter 2017. These sessions will commence in May 2017.

Please select which Creative Connections dates the service user would like to attend in May 2017:

Wednesday 31st May NorwichWednesday 31st May AttleboroughFriday 2nd June NorwichFriday 2nd June Kings Lynn

Please select which Creative Connections dates the service user would like to attend in Summer 2017:

Wednesday 2nd August NorwichWednesday 2nd August AttleboroughFriday 4th August NorwichFriday 4th August Kings LynnWednesday 16th August NorwichWednesday 16th August AttleboroughFriday 18th August NorwichFriday 18th August Kings LynnWednesday 23rd August NorwichWednesday 23rd August AttleboroughFriday 25th August NorwichFriday 25th August Kings Lynn

Please select which Creative Connections dates the service user would like to attend in October 2017:

Wednesday 25th October NorwichWednesday 25th October AttleboroughFriday 27th October NorwichFriday 27th October Kings Lynn

Please select which Creative Connections dates the service user would like to attend in February 2018:

Wednesday 14th February NorwichWednesday 14th February AttleboroughFriday 16th February NorwichFriday 16th February Kings Lynn

Please select which M-Power dates the service user would like to attend between April 2017 - February 2018:

EasterMaySummerOctoberFebruary

There are no M-Power sessions scheduled for Easter 2017. These sessions will commence in May 2017.

Please select which M-Power dates the service user would like to attend in May 2017:

Wednesday 31st May and Thursday 1st June Norwich

Please select which M-Power dates the service user would like to attend in Summer 2017:

Wednesday 9th August and Thursday 10th August NorwichWednesday 16th August and Thursday 17th August NorwichWednesday 30th August and Thursday 31st August Norwich

Please select which M-Power dates the service user would like to attend in October 2017:

Wednesday 25th October and Thursday 26th October Norwich

Please select which M-Power dates the service user would like to attend in February 2018:

Wednesday 14th Febraury and Thursday 15th February Norwich

Please select how frequently you wish to attend Express Breckland:

WeeklyFortnightlyMonthlySpecific Holiday Dates (we will get in touch to confirm)