Applications are accepted from and on behalf of children living with a life threatening/terminal illness, chronic disease or disability between the ages of 0-18, living in Essex. Please refer to our general information form for full details. You can also download a referral form and media disclaimer below.

About the child

About the family

About the Referrer

About the Childs Doctor/Consultant

We will need to contact the Child's Doctor/Consultant who will confirm medical information. Please check the consent box below:

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