Your Name (required)

Your Email (required)

Your Telephone Number

Who would you like to refer? (please include age of children)

Family’s Address (required)

Any additional Information (please use this space to inform us of any disabilities or special requirements the family have)

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Your privacy is important to us, and we would like to continue to communicate with you in a way that is in line with UK law on data protection.
The General Data Protection Regulation (GDPR) is coming into effect in May 2018 and as result of the changes in data protection laws, we need your consent for us to continue to contact you.
By signing this form you are confirming that you are consenting to Grant A Smile holding and processing your personal data for the purpose outlined in our privacy notice available to read here : https://www.grantasmile.org.uk/privacy-policy/
(Please tick the boxes where you grant consent):-
I consent to Grant A Smile contacting me by:
postphoneemail
To keep me informed about my support, child wish application, news, events, activities and other services. (note you can unsubscribe from the mailing list at any time);To including my details in organisation database which is could be used with volunteers, employees, contractors and other government support agencies/organisations
Please type full name below
Signed:
Date:
You can withdraw or change your consent at any time by contacting the Office Administrator at admin@grantasmile.org.uk. Please note that all processing of your personal data will cease once you have withdrawn consent, other than where this is required by law, but this will not affect any personal data that has already been processed prior to this point.