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We take referrals for children and their families affected by the death of a parent or sibling.

To refer a family you will need to provide your name and contact details as well as the families name and contact details. We would also need a brief outline of the circumstances so we can ensure they reach our registration criteria.

Once the referral has been received we will contact them, requesting that they complete registration details online, so ideally they will be aware that you are referring them. However, if this isn't the case we can instead send a letter and information by postal address to you as an alternative.

About the referrer

First Name *

Last Name *

Email *

Phone Number

Address 1

Address 2

City

County

Postal Code

Referring from *

Referring From (Other)

We will hold your information for our records. If you are happy to be contacted about our charitable activities please tick the box to subscribe

Tick to confirm

About the family

Do the family know you are referring them? *

Yes No

Would you like to receive registration information by post? (if the family are not aware)?

Yes No

Main parent/Guardian Full Name *

Referred Family Email *

Contact Telephone

Address

How many children live within the family home?

Have they been bereaved of a Parent/Sibling?

Yes No

Referral Reason

OUR CHARITABLE AIMS

We became a fully registered charity in September 2012. Our registration number is 1149011.

To relieve

children and young people and their families who have been bereaved through the loss of a significant loved one such as a parent or sibling.

By providing

Access to support and advice

Recreational and leisure activities to children and young people in order to improve their conditions of life and to reduce the isolation felt during bereavement, by facilitating contact with other children and young people.

By raising

Public awareness of the need for support and guidance and providing access to information about coping with bereavement.

NEED HELP OR KNOW SOMEONE THAT DOES

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About the referrer

About the family

OUR CHARITABLE AIMS

To relieve

By providing

By raising

NEED HELP OR KNOW SOMEONE THAT DOES

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