Care & Connect Family Support Bag Application Form

Our intention is for each child and family living in the UK and in active treatment for neuroblastoma (which includes enrolment on a clinical trial in the UK or overseas) to receive one of our Family Support Bags.

If you have any questions about eligibility for a support bag or anything else, you can email support@solvingkidscancer.org.uk or give us a call on 0207 284 0800.

About you

Complete this section with your information.

I am making an application *

I am a

Title *

First name *

Last name *

Email *

Telephone *

Address *

First name *

Last name *

Healthcare institution/organisation *

Email *

Telephone *

How did you hear about the Family Support Bag? *

About your child’s Clinical Nurse Specialist

First name *

Last name *

Institution *

Please upload a letter from your treating centre or send it to familygrants@solvingkidscancer.org.uk.

About the child / young person in active treatment

Child's first name *

Child's last name *

Gender *

Age *

Treating centre *

Staging of disease at diagnosis *

Date of diagnosis *

Please confirm you are their parent/guardian *

About the bag

What is the child / young person’s preferred name for the bespoke print? *

What colour would you like the preferred name to be printed in? *

Please provide the address that you would like the bag delivered to? *

Can we keep in touch with you?

By email *

By text *

By phone *

We will tell you about how we’re driving change for families affected by neuroblastoma through our research, support, and awareness work as well as about different fundraising events and initiatives including our children’s campaigns for access to treatment.

We will always keep your details safe and will never share them with other organisations for their own marketing purposes. You always have a choice and can opt-out of receiving communications from us at any time. You can use the unsubscribe link on emails received or contact us at info@solvingkidscancer.org.uk. For more information, please see our privacy notice.

Our Family Support Service

Would you like to hear from our Family Support team (by email) to find out how we support families?

Would the family you are applying on behalf of like to hear from our Family Support team (by email) to find out how we support families?

Please provide the name and email address of the person we should write to (if different to the parent/guardian details shared above)

Declaration

I confirm that all the information provided is accurate to the best of my knowledge *

I confirm that the child / young person that the application relates to lives in the UK. *

I confirm that the child / young person that the application relates to is in active treatment for neuroblastoma, which can include being enrolled on a clinical trial either in the UK or overseas *

I confirm that a support bag has not already been provided *

I consent to SKC using the health data included on this application form for the purpose of administering and recording this grant and analysing, reviewing, and reporting on this service *

For more information on how we use your personal information, please see our privacy policy

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