Alex’s Gifts Application Form

Thank you for applying for your child to receive a birthday gift from Alex at the Kerry Alex Thorpe Trust. Your child will be given a birthday present of the parent or guardians choice, up to £25.00 on every birthday until the age of 9 when they become eligible for one of our Wish Days. Please complete the following form and we will contact you nearer the time to arrange the gift and a convenient time for us to deliver.

 

Alex cartoon

Name of Child Applying:

Date of Birth of Child Applying:

Name of Parent(s)/Guardian(s)

Address:

Postcode:

Telephone:

Mobile:

Your Email (required)

Confirmation:
By checking this box I confirm that my son/daughter is under the care of The Ipswich Hospital Cystic Fibrosis Children’s Clinic.