Logan’s Fund Grant

Applications Form

Please use this application to apply for Logan’s Fund to provide something that will be of benefit to your child and your family. Our aim is to provide a focus away from hospital and treatment with something that will bring a smile or just meet a practical need whether it be today, tomorrow or a year from now. Please note that ‘Logan’s Sunny Days’ and the ‘Always a Rainbow’ sponsorship program have their own unique application forms.

1. Personal Details

Childs Name

Date of Birth

Male or Female

MaleFemale

Illness/Diagnoses

2. Family

Parents/s (or Guardians) name/s

Home Address & Postcode

Preferred contact number/s

Your Email

Child’s siblings/ages

3. 3rd party referral - This section is only to be completed if you aren’t the child’s parent or guardian. We will gladly accept referrals from out with the immediate family (e.g. other family member, friends, other charity, professional representative etc). Please complete this section if this applies to this referral. Please note we will always contact you in first instance before contacting the child’s parents/guardians.

Name/s

Relationship to family

Contact Number

Your Email

Is the family aware of this referral (Y/N)?

YesNo

4. Medical Journey - It is helpful to us to have an overview of the treatment undertaken so far, current situation and proposed treatment.

5. Further information - Anything further you would like to tell us about your child, your family, circumstances.

6. Grant - Please describe what you would like to apply for. If we haven’t granted it in the past it could just be because no-one has asked for it so far. If you are unsure at this stage or would like to chat about possibilities just write ‘chat’ in the box. We will contact you to discuss in all instances anyway as we want to ensure the best possible outcome for your child and your family.

7. Publicity - Would you allow us to publicise any award we make on our website/social media pages?

YesNo

We will always respect your wishes and level of privacy. There may be certain occasions where we think certain grants may be worthy of a press release – again we will always discuss the possibilities of this before we take any action.

NB If you are applying for a grant for a vacation or trip while treatment is still ongoing you will need to seek medical release permission from your child’s consultant/doctor.