Please be aware you will be asked to attach copies of the following documents later on in this form :
These must be recent copies (not older than 12 months).
i Either the person who has full parental responsibility for the child and who the child lives with or, the young person applying on their own behalf should complete this section.
i We need your bank details so that we can pay any cash grants directly into your bank account.
‘Take a Break’ is not able to make payment into Post Office accounts.
We may need to contact you for more details about how we can help administer a grant award.
i Please complete this section as fully as possible. This may help speed up your application. We need to know about your child. If you are a young person applying for yourself please complete this section.
i Tick the Rate of Disability Living Allowance (DLA) or Personal Independence Payments (PIP) your child has been awarded. You must upload a copy at the end of this form, e-mail a copy after you have completed this form or send a photocopy by post following the instructions at the end of this form. We cannot return original documents to you.
i This means things like formal provision for your child; weekend or evening care, activities, mentor or buddy scheme to take your child out and about.
i We will need to see a copy of your child's Plan
i We will need the name of your family’s Social Worker, Key Worker/Lead professional, Health Visitor, Community Children’s Nurse, Nurse, Portage Worker or similar who knows your child well (not your GP) and who we can contact for more information.
Tell us what you would like to use your ‘Take a Break’ funding towards.
i Our leaflet has some important information about what we can consider and some helpful ideas about how you might want to use your grant. We expect our average award to be between £300 to £500 though we may be able to consider a larger contribution in exceptional circumstances or towards specific specialist equipment.
! You need to upload supporting information with this application. Alternatively you can e-mail it to Take a Break or send it by post by following the instructions at the end of the form. We cannot process incomplete applications.
This button will submit the application!
Please wait a few moments while we process your application - this may take a few seconds, especially when uploading your documents