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Child's details (1 of 7)
Child's name, contact details and date of birth
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We will use this as your main number (this is normally the house phone number)
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or guardian
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Example: If you were born on 1st March 1990 enter: 01/03/1990
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Parents (2 of 7)
If the child does not live with their parents, please complete the male and female guardian's details in the father and mother fields.
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Choose the main contact who we can contact about the child
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This is just so we know who to send application forms to. This can be changed at a later date.
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Or other female guardian
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Or other male guardian
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Please state which parent lives here
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Emergency contact details - if parents are unavailable (3 of 7)
If we are unable to get in contact with the parent's we need details for someone else.
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Medical information (4 of 7)
An overview
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When you were first told your child had their illness (if you're unsure of the day, just put "01" for day
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ie: Neuroblastoma, Acute Lymphocytic Leukaemia
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Please let us know, for example, if the child get's tired easily, will be neutropenic or cannot swim due to central line, wets the bed etc etc
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Leave blank if child never on treatment (if you're unsure of the day, just put "01" for day)
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Primary consultant responsible for your child's treatment who we may contact to confirm these details or gain further information.
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If treated at several centres, please list where your child's main consultant is based
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A little more info (5 of 7)
We'd like a fuller picture of your child to enable us to serve them better
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ie, has the child been bullied?
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The child may be given a t-shirt or poloshirt at camp?
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A bit about you (6 of 7)
So we know who we're talking to
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If "Yes" please skip to section 8 "The legal stuff"
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So that we may contact you with more information
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The legal stuff (7 of 7)
Please read the following very carefully
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