Respite Application Form

Dear Sir/Madam,

Unfortunately, the 4 Cancer Group has reached its allocation of holidays for 2019 and is therefore unable to process any new nominations for holidays at present. When this situation changes we will be in touch.

However, if you have nominated someone for a sailing day this summer, we will be in contact shortly with more information.

Thank you for your understanding.

Yours faithfully,

4 Cancer Group

Application Form

Your name:
Your email:
Your phone no:
Nominee name:
Nominee email:
Nominee phone no:
Nominee Address:
City:
Postcode/ZIP:
Country:	*
Your relationship to the nominee (e.g. friend):
Does the nominee know that you have put his/her name forward?	Yes No
Are you comfortable that we now contact him/her directly?	Yes No
Which sailing option are you interested in:
Please could you give the reasons why you feel this person would benefit from a sailing experience/holiday with Sail 4 Cancer:	Please include as much detail as possible, including the dates of illness, the severity and the ongoing prognosis; the age of the nominee, current level of fitness (i.e. are they well enough to go sailing/on holiday) and how you feel a holiday/sailing experience will help them.
Where did you hear about Sail 4 Cancer?:
Please give details of any Sail 4 Cancer activities you have been on before: