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The Child

THE FAMILY

Do the Parents/Guardians co-habit?

WISHES & DREAMS

FINANCIALS

HouseHold Income

FINANCIALS - CONT

Household Expenditure

CLAIMS

Have you successfully applied to The Boparan Charitable Trust before?

LEGAL CLAIMS

Have you received any compensation by way of legal claim in regards to your child’s condition?
Are you currently pursuing a legal claim regarding your child’s conditions?

PUBLICITY ‘Help us, to help others!’

At The Boparan Charitable Trust we produce a wide range of materials to tell people about our services and to raise money for our work. From time to time we take photographic images (moving and still) of applicants, and use case studies which can include these images and personal data (such as name and/or diagnosis where appropriate and consented to) to enhance and illustrate our media applications to make them more accessible, and inspiring for our audiences. By completing this form, you confirm that you:

  •  understand that footage and photographs may be used at different times and that I will not be contacted each time and that any materials, footage and photographs may be edited or altered to be used; and

  • give us full permission to use these images and any personal information you supply to us in our media applications, which reasonably promote or advertise The Boparan Charitable Trust aims. (This may include printed publications and leaflets; adverts; our website; audio-visual and electronic materials; media work; display materials; and any other media we may use in the future.). The images will not be used for any other purpose.

The copyright and any intellectual property rights in any material which is generated as a result of photographic sessions shall be assigned and shall be the property of The Boparan Charitable Trust.

CHECKLIST

Your form:







#Address#







  • Fully completed application form 
  • Written confirmation of child’s condition by a professional independent body e.g. Medical Consultant or Social Worker. **(Minimum requirement for wheelchair must be confirmation from a medical professional who were present at the assessment and will state this is the correct chair for the child) stating benefit to the child.
  • Independent quote.

Please be aware The Boparan Charitable Trust may contact you at any point to clarify the information provided.

 

DECLARATION:

Although this application can be completed by a supporting advocate of the child, this must be signed by the parent/legal guardian () to validate information given.

All the details that I/we have provided within this application are correct and true to the best of my knowledge. I fully understand that failure to disclose the correct information will invalidate my application.

Ticking the box certifies a signature