Meadow Lodge Stay

If you are interested in staying at Meadow Lodge accessible accommodation at Lea Green Centre, please complete the below form. If you have any queries please contact us by calling 01629 534561 or email leagreen.admin@derbyshire.gov.uk

Meadow Lodge booking form

Group / Organisation
Course organiser*
Group leader (attending the course)*
Telephone number*
Email address*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Invoice name and address (if different)
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Arrival date*
Arrival time

: HH

MM
Departure date*
Departure time

: HH

MM
Number of people*
Age range of group
Number of staff (if applicable)
Are you booking a catered or self catered stay?*
Would you like to book any Lea Green Centre activities?*
Please give a brief description of the additional needs within the group including any mobility information*
Do you have a specific programme in mind? e.g. If you have been before, would you like the same/different?*
Brief description of activity programme required / activities you would be interested in (if applicable)*
Are there any activities you would particularly like to include in your programme?*
Any other information you would like to tell us?*
Please enter your DCC Cost Centre for internal charging (if applicable)