Application For Help – Child Funeral Charity

APPLICATION FOR FINANCIAL ASSISTANCE

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
Full name of child

Date of birth

Date of death

Age or number of weeks gestation

Date of funeral

Parents/Family details
Name

Address

Postcode

Phone number

Email address

Preferred method of contact (please select one)
emailphone
Details of Referrer
Name

Profession

Organisation/Company

How do you know the family?

Address

Postcode

Phone number

Email

Preferred method of contact (please select one)
emailphone
How did you hear about CFC?

Funeral Details (if known)
Location of funeral

Name of Funeral Director (if known)

Location of Funeral Director

Any other funeral details

Financial Assistance request details
Please describe, in as much detail as possible, what you are requesting

To help us make a decision, please explain why this family/parents need our help

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.
I agree
UNFORTUNATELY SOME ORGANISATIONS ARE HAVING DIFFICULTY SUBMITTING THIS FORM DUE TO FIREWALL SETTINGS. IF YOU RECEIVE AN ERROR MESSAGE, PLEASE HIGHLIGHT ALL FIELDS WITHIN THE FORM, COPY AND PASTE THE DETAILS INTO AN EMAIL AND SEND TO: [email protected]
Apologies for any inconvenience caused and we are working to rectify this.