Residential

If you would like to book a residential stay 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

Residential 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
Invoice name and address (if different)
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Arrival date*
Arrival time

: HH

MM
Departure date*
Departure time

: HH

MM
Number of students*
Age range of students*
Number of staff*
Learning outcomes*
What are the aims and learning objectives for your course? (Examples - teamwork, confidence building, problem solving, developing positive attitudes)
Are there any activities that you would particularly like to include in your programme? Please list.*
Do you have a specific programme in mind? e.g. have you been before and what something the same/different?*
Do you want the course to support / meet any other curriculum objectives? Please give details.*
Any other information (e.g. wheelchair access, additional needs, medical information).*
Food / Drink requirements and times for these*
Please enter your DCC Cost Centre for internal charging (if applicable)