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Phone: 01480 276088 or Email: [email protected]


Please note that this application form should only be filled in by a professional who has knowledge of the bereaved family and their circumstances. This could include: Funeral Directors, Celebrant or Faith representatives, Bereavement Nurses or Midwives, Hospice Managers, General Practitioners, Local Authority Registrars, Hospital Bereavement Officers, Hospital Medical Registrars etc.

Please note – We are unable to take applications from family members.

    Child/Baby details

    Parents/Family details

    Preferred method of contact (please select one)

    Details of Referrer

    Preferred method of contact (please select one)

    Funeral Details (if known)

    Financial Assistance request details

    By submitting this application to Child Funeral Charity, you are confirming that the details provided are accurate.
    You also confirm that:
    The child was between 12 weeks gestation and 16 years of age.
    You are not a family member.
    Please note - We endeavour to respond to all applications within 48 hours, but if you have not had a reply within that timescale, please telephone 01480 276088.
    In line with our Privacy Policy and to process your referral, we may need to send your details on to one of our suppliers so that they can contact you to make sure the requirements are accurate. By submitting this form, you are agreeing to this action. We only forward e-mail addresses.
    We might need to contact you in the future to let you know about changes in funding arrangements and our educational events.
    If you would like us to maintain your details on our database for this purpose, please check this box.

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