Holiday Booking Application Form – Irish Kidney Association

I confirm that I have read and accept the booking terms and conditions. *

Yes

If you are free to travel any time or at short notice if a cancellation occurs, please tick here.

I can travel any time or at short notice

Please select the start date of your preferences for Tramore, Tralee or Killarney below. More detailed information on each location will be forwarded when booking is confirmed. All holidays start on Saturdays. You can select a date for more than one location.

Please only select dates between the available months for each home, selecting any other dates may delay your application.

Available months:

Tramore: April 2022 - October 2022

Tralee: May 2022 - April 2023

Killarney: May 2022 - April 2023

Tramore Date Selection – 5 night basis

Tralee Date Selection – 5 night basis

Killarney Date Selection – 5 night basis

Which is your preferred location? *

Have you previously had an IKA Holiday in Tramore, Tralee or Killarney? *

Yes
No

When did you last have a holiday in Ireland or abroad? Month and year is enough if you can't recall exact dates.//

If you wish to avail of financial support, please tick yes.

Yes

Patient name *

First

Last

Email *

Contact Number *

Secondary Contact Number

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Primary treating hospital or clinic *

Currently treated by *

HD
PD
Transplanted (TX)

Including yourself, how many people would be staying in our accommodation? *

Please give the names, ages, and relationship to patient of any accompanying people. *

If you or your accompanying guests have any special needs please bring them to our attention (e.g. drip stand, visually impaired, wheelchair, commode etc.)