Clubs Referral Form

We have recently closed our individual referrals.

We now directly provide funding to organisations so that they can distribute funds for activities to families they work with directly. Please fill in the form below and we will be in touch to discuss the funding you wish to apply for.

Examples of organisations we work with:

Domestic Abuse Support Services,
Children’s hospice Services,
Educational Trusts.

Name of organisation

Email contact

Phone contact

How many families you plan to provide the funding to within 3 months (minimum of 5)

Additional information

I confirm that we are able to receive funding from Active Respite to distribute to our families.

Yes

I confirm that we are able to review engagement and review the families we provide funding to, as to provide this to Active Respite at the end of the 3 months.

Yes