Nominate a Special Child

Thank you for your interest in our charity for Children with Life Threatening Illnesses. Please take the time to complete the form below.

The information you provide is strictly confidential. We welcome applications from people of all abilities, backgrounds and communities. The Les Hoey MBE DreamMaker Foundation abides by the Data Protection Act 1998 and operates an Equal Opportunities Policy.

The fields highlighted red are required.

Child's Details:

Forname
Surname

Address

Postcode

Tel (Day)
Tel (Evening)

Date of Birth

Parent/ Carer Contact Details:

Name
Relationship

Address

Postcode

Tel (Day)

Health:

Childs Life Threatening illness:

What hospital does your child attend?

Your child's consultant details:

Your Likes:

What are you interested in?

Favourite Music:

Favourite Celebrity:

Favourite Sports:

Favourite Cartoons:

What would you Like DreamMaker to do for you?

Is there anything else you would like us to know about you application?

Personal Declaration:

By submitting this form I agree that Les Hoey MBE DreamMaker Foundation may hold and use the data in this form for the purposes of administering within the charity and that such data may be available to those who reasonably need to know the same within the charity. You also give consent for the charity to contact your childs hospital or consultant.

By submitting this form I also give my consent for photos or videos of my child to be used by les Hoey MBE DreamMaker Foundation SCIO. If you would like to be removed from our database please contact us

If you would like to print out the form and fill it in by hand, you can download it here:

Download Form

Post to: Les Hoey MBE DreamMaker Foundation, Block 2 Unit 2, Etna Industrial Estate, Motherwell ML2 7XQ.