Promise Dreams Application Form

Please read carefully to understand our requirements

To apply for a dream we require the parent or legal guardian of the child to complete the application form. We ask for as much information as possible, including any other dreams that have been given by other charities and applications for funding from any other sources.

Please ensure you answer ALL questions. If full information is not provided this will slow down your application.

When applying for a dream we ask families to consider where they will raise additional funds should only part funding be available for their child's dream. Due to funding limits, Promise Dreams will often offer part funding and not full funding for the dream. Please consider alternative funding if you apply to us for expensive dreams.

In addition to the completed and signed application form, we also require two letters of support. One must be from the child's GP, Consultant or Senior Nurse Practitioner, and the second can be from the child's Social Worker, Community Nurse, School Teacher, Health Visitor or similar support person holding a title of authority. Each letter must:-

1. Be on their official letter headed paper

2. Be addressed to Promise Dreams

3. Be dated within the last 3 months

4. Outline the following:

Confirmation of the illness/medical condition of the child and the severity of this condition/illness.
Confirmation of what the dream is and why they support that particular dream.
Confirmation that the dream would not be hazardous to the child (eg. able to fly for overseas

For a dream holiday application we need to know the names and ages of all passengers travelling; preferred dates of travel and any special requirements (such as wheelchair access, roll-in showers, hoist provision.

In the case of dream holidays it is likely that, should the Trustees' Committee approve the request, an offer of a donation towards the total cost only would be made and the family would need to raise theremaining funds from other sources.

PLEASE REMEMBER TO CONSIDER SPECIALISED INSURANCE FOR YOUR HOLIDAY. Should the holiday not be able to proceed for any reason, and you make a claim on your insurance, any monies paid by Promise Dreams will need to be refunded.

We are not travel agents so it is recommended that you seek professional advice if needed.

Due to continuing increases in applications received, and the constraints of limited funding, Promise Dreams operates a "once only in a lifetime" policy for dream requests - ensuring we are able to help as many children as possible.

We will consider applications on behalf of children who have had a dream previously from another charity, however, our decision will be based on details of the previous dream and when it was granted.

Once we receive all the information, your application will be reviewed and then put before the Trustees' Committee. The Trustees use criteria to select applications they are able to approve and the funding available is based on set funding limits.

Each application is carefully reviewed and considered but, regrettably, we are not able to help with every request due to limited funding resources. Our decision is not open to appeal.

Please note that if your dream is approved and we are working with you to fulfil this, if new information comes to light that may affect your application, we have the right to withdraw our offer of help.

Please be advised that when applying to Promise Dreams you are agreeing that your child's name and dream may be shared with other wish granting charities. This information will only be used to ensure that all applications are reviwed fairly.

Promise Dreams will respect any personal data you share with us and keep it safe. We aim to be clear when we collect your data and not do anything you would not reasonably expect. Upon application, we may need to pass your details to third parties in order for us to fulfil the dream but this will not be used for any other purpose.

If you have any questions, or require any further advice about applying, please contact us on 01902 212451 or email: info@promisedreams.co.uk

1. Child's name

Child's date of birth

Date

Parents/Guardians full names

Address

Street Address

Street Address Line 2

CityPost Code

Email address

example@example.com

Contact Number

2. Are you a British citizen? (Proof of this may be requested)

3. Names and dates of birth of all brothers/sisters living at the above address:-

Rows	Name	Date of birth
Sibling
Sibling
Sibling
Sibling
Sibling
Sibling

4. Details of illness / medical condition

5. Description of the impact that this medical condition has on your child's day to day life

6. How long has your child been affected

7. For cases of cancer and leukaemia, is your child currently undergoing treatment

8. Name of primary consultant and address of hospital where child is being treated

9. Name of your child's GP and surgery address

10. We require two letters of support for this application. Please upload them below.

Please see page 1 for details of our requirements. Please do not submit your application form without both supporting letters.

File Upload

Promise Dreams makes dreams come true for seriously and terminally ill children and we appreciate that this terminology covers a wide range of medical conditions.

In certain cases we may need to approach your child's GP or Consultant for further information.

With this in mind, can you please confirm your permission for us to contact the authors of your supporting letters by signing and dating the form below.

Signed

Print Name

Date

12. What is your child's dream?

For a dream holiday include the desired dates of travel, number of passengers and any special requirements.

13. Why have you chosen this dream? Are there any special reasons behind it?

14. What difference will this dream make to your child / family?

15. Please tell us about your child - their personality and what hobbies, interests and activities stimulate them

Please note that Promise Dreams operates a "once-in-a-lifetime" policy. If your child has already been granted a dream from us we will not be able to help you again.

16. Have you previously received help from a charity or other supporting organisation? If yes please give details below.

Rows	Name of Charity	What help did you receive?	When
1.
2.
3.

17. Have you asked anyone else to help you with this particular dream? If yes please provide details of whom you have asked and how they are helping

Due to funding limitations, Promise Dreams is not always able to fully fund every application.

Please consider the below questions carefully before completing your answers.

18. Have you been able to save or raise any funds yourself for this dream? If yes how much

19. Do you have any fundraising activities planned?

If yes, please provide details and how much do you expect to raise?

20. If we were able to offer a donation towards this dream from where would you try to obtain funding not outlined above so that the dream can be achieved?

21. How did you hear about Promise Dreams?

22. CAN YOU HELP US TO HELP YOU? To help raise the profile of Promise Dreams so that we can help more children, many families we help allow us to use their story and photographs in publicity material and appeals. Please confirm if you are willing to help with media for Promise Dreams which may be inclusion on our social media platforms and website, and press releases in local, regional and national publications.

Please upload photos of your child below.

23. We are also looking for families who are happy to be filmed talking about their dream request; receiving/experiencing their child's dream (circumstances allowing) or talking about how the dream has made a difference to their lives. This footage may be used as promotional material to enable us to raise more funds and fulfil more dreams. Is this something you would be willing to help with?

Would you like to be added to the Promise Dreams supporter database and receive further information including Newsletters, event information and future activities.

If you change your mind at any point in the future please let us know and we can update your preferences.

I/We have read and understand the information provided in this form, especially with regards to use of our information and publicity. By signing this application I agree for Promise Dreams to share my data for Dream completion

I/We confirm that the details provided are true and accurate.

Signature of parent/guardian

Date

Name

If this application needs to be processed on a fast track basis please provide information here -

DREAM APPLICATION FORM