Download Application Form
For referrers already registered with Dragonfly Cancer Trust.
Due to the sensitive nature of referrals, please do not email your application. In line with General Data Protection Regulations, applications sent as an attachment will not be opened.
Please send all applications via Mimecast secure mail using email@example.com
If you know a child or young person with a palliative diagnosis who you think would benefit from our support, get in touch.
What makes us different
- All applications are assessed on an individual basis and are not means tested.
- We will consider applications regardless of any support you may be receiving from other organisations.
- We’ve got a wonderful Board of Trustees who are able to approve applications very quickly.
- Our team are always going the extra mile to make each request super special.
Things to consider
- Applications are open to palliative cancer patients aged between 0-24 years old.
- Our focus is on creating memories and this should be at the centre of every application.
Who can apply
If you’re a parent, carer, health professional or organisation (eg. hospice / hospital / specialist cancer centre) and would like further information about making a referral please call 0191 261 0971, email firstname.lastname@example.org, or complete the contact form below.
If you are ready to submit an application, this must be sent via Mimecast using the address email@example.com
Please note, our team are currently working from home and can be contacted on 07491641668.