The Happy Shack Enquiry Form

Please note all our bookings are subject to availability and at the discretion of the charity. Priority is given to families who have not already utilised The Happy Shack.

Due to the demand for our services we are unable to offer the use of The Happy Shack to children/teenagers who have been in remission for over five years.

Each family can only use The Happy Shack once during school holiday periods.

By completing and returning this application form, you are agreeing to adhere to The Happy Shack Terms and Conditions.

DATA PROTECTION

The information which you give will be used for the following purposes; to enable Unlock a Life for Lockey to create an electronic and paper record of your application; to enable the application to be processed; to advertise other services offered by the charity; to enable the charity to compile anonymous statistics. The information will be kept securely, and will be kept no longer the necessary.

Name*

Email*

Contact Number*

Home Address (of lead booker)*

Diagnosed Child's Name (if applicable)

Child's Date of Birth (if applicable)

Child's Illness (if applicable)

Date of Diagnosis (if applicable)

Is the Child Currenty Receiving Treatment? (if applicable)

Name of Consultant or Social Worker (if applicable)

Name & Address of Hospital (if applicable)

No of People Wishing to Use the Happy Shack*

Names, Dates of Birth & Relationship to Child of People Using the Shack*

Preferred Date of Use*

Alternative Preferred Date of Use*

Have You Used the Happy Shack Before? (please give last date)*

Where Did you Hear About the Happy Shack?

* Required

The Happy Shack Enquiry Form

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