Application Form – Frenkel Topping Charitable Foundation

Please provide details of family member with severe injury/illness/medical condition
Name*
DOB*
Date Format: MM slash DD slash YYYY
Details of injury/illness/medical condition*
Financial situation (please provide details of whether parents are working) The affected individual and their family must be unable to support themselves financially*
Why do you feel we should consider your family for our Christmas Campaign*

Family Details
Name of Mum*
Name of Dad*
Family Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Please provide the name, DOB and gender of each child
Name DOB Gender
Is the family happy to be identified or would they prefer to remail anonymous*
- We are happy to be identified
- We would prefer to remaining anonymous
Would the family be happy for us to take and share photos/video footage*
- Yes
- No

Consent
Please complete so that we can process your application
I consent to the processing of sensitive personal data as far as it is necessary for the services I require from Frenkel Topping Charitable Foundation*
I consent to the processing of sensitive personal data as far as it is necessary for the services I require from Frenkel Topping Charitable Foundation*
From time to time, we may wish to contact you to offer additional products or services which may be of interest to you. In order to do this, we require your consent by agreeing to one or all of the options: I/we consent to be contacted for marketing purposes by:
- Email
- Telephone
- Text message
- Post

Name	DOB	Gender

Christmas Campaign Application Form