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Getaway Enquiry

Booking Form

1Enquiry

2Your Details

3Contact Details

4Service Details

Holiday Title
Hidden
Tour Code
Would you like to make an enquiry or booking?
- Enquiry
- Booking

Your Enquiry
Your Name
First Last
Email
Phone
Enquiry
Would you like to receive our newsletter which includes updates on new holidays?
- Yes
Traveller Details
Guest Name*
First Last
Address*
Street Address City State Post code Country
Preferred Language
Who is the primary contact for this booking?*
- Self
- Someone Else

Other Contact
This could be the person making this booking or an emergency contact
Name
First Last
Email*
Phone*
Other contact's relationship to the traveller
- Friend
- Family
- Service Provider
- Guardian
- Parent
- Personal Representative
Is this person assisting you with this booking?
- Yes
- No
Name of the person assisting you with this booking
First Last
Phone Number of Person Assisting you with the booking

Guest Service Planning
Have you completed a Guest Services Plan or Booking Summary?
- Yes I am a returning Guest
- Yes I have provided a New plan
- No I am completing soon
- I would like assistance with this
- Unsure or Other
My holiday and support services style is...
- Active paced low support (1:4)
- Relaxed paced low support (1:4)
- Relaxed paced high support (1:2)
- Relaxed paced high support (1:1)
- Unsure or Other Support Preferences
Do you have any Itinerary or mobility related accessibility requirements?
- No Mobility Aids / Good Mobility
- No Mobility Aids / Low Mobility
- Travelling with Walking Aid Stick
- Travelling with Manual Wheelchair
- Travelling with Electric Wheelchair
Please describe any special requests...
for example accessibility, dietary requirements, allergies, or other requests
Do any of the following apply to this booking?
- NDIS Funding
NDIS Participant Number*
- Trustee Approvals
Trustee Contact Person*
First Last
Trustee Email*
- Guardian Approvals
Guardian Name
First Last
Guardian Email
What is the best time to for the team to contact you to complete your holiday reservation?
preferred day of the week and/or time
Would you like to receive our newsletter which includes updates on new holidays?
- Yes
Comments
This field is for validation purposes and should be left unchanged.

Social Solutions WA

ABN: 46 163 536 105

Since 2013, Social Solutions WA has been providing innovative out-of-home support solutions and social opportunities for adults with disabilities.

NDIS Registered

Head Office

Level 2 Building C 355 Scarborough Beach Rd Osborne Park WA, 6017

Postal Address: PO Box 793 Cloverdale WA ,6105

Phone: 1800290996 or 08 94414854

Social Solutions WA acknowledges the traditional owners of country throughout Australia and their continuing connection to land, sea and community. We pay our respects to them and their cultures and to their elders both past and present.