Your Name: *

Your Mobile Number: *

Your Email: *

Your Address: *

Your Post Code: *

Why You Should Be Chosen: *

Any Additional Needs or Requirements:

Names Of All Attending: *

Ages Of Children: *

Declaration

• I declare that the information in this application is accurate and gives a true account of the present financial position, and that the relevant supporting documents can be provided if required.

• I understand the information I have provided will be used to process this application for assistance.

Social Media

Do you give consent for the foundation to share photos and your experience on our social media platforms? *

YesNo

Please Note

If you are not able to attend at short notice, can you please contact Jill on: 07895290891, so that she can give another family a chance to attend.

Consent

At times, we will not be able to assist but may be able to approach other agencies/charities to see if they are willing to help you. Your details may be shared with these charities/agencies in order that we may try to obtain help on your behalf. If you do not wish us to contact any agencies/charities on your behalf this will not prejudice your request for assistance. If assistance is provided by the Foundation it will be used in our marketing/social media platforms to promote the Foundation and its objectives and you agree to this use.