Wish Day Application Form

Thank you for applying for a wish from the Kerry Alex Thorpe Trust.  Please complete the following form.

 

 

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. 

On receipt of your form someone from the trust will be in contact to arrange an appointment. We will then meet you and discuss what kind of wish your child would like.  This could be a personal wish or one that includes the whole family.  We will then arrange the wish and hopefully create a wonderful memory for the child and his/hers family to treasure.

Terms and conditions – Wishes are only available to children who attend the cystic fibrosis childrens clinic at Ipswich Hospital and are aged between 9-16.  Wishes have a maximum value of £400 and will be arranged entirely by the Kerry Alex Thorpe Trust.  No money will be available to spend personally unless this is agreed by us during the arrangement of the wish.  Only one wish will be granted per child.

 

Kerry Alex Thorpe Trust, 3 Pontins Walk, Grange Farm, Kesgrave, IP5 2BW
Tel: 07835 167765  Web: www.kerryalexthorpetrust.org.uk  Email: info@kerryalexthorpetrust.org.uk