Youth Cancer Trust application form for holidays and online support.
If you are eligible for a Youth Cancer Trust Holiday, please complete and submit the following full application form. If you are unsure, please complete the enquiry form or contact us on 01202 763591. Once we have received your submitted form, we will be in touch to arrange the details of your holiday.
Sign up to Realshare Online Support – Please also complete and submit this form to join our Realshare community – our FREE online support and activity programme. Once we have received your form, we will be in touch with your login details and to talk to you about all the activities on offer and how to take part.
We NEVER share your details with anyone - anything you share with us is private and confidential.
Current On-going Medical Status
PLEASE NOTE - To meet the criteria for a Youth Cancer Trust holiday, the applicant will need to be able to self medicate.
Please List Your Current Medicines:
Current Medical Issues:
In this section, please describe how your current diagnosis and treatment affects you. Also include any other health issues we need to be aware of.
Are you fully vaccinated for Covid 19 (this means 2 vaccinations and a booster)? [radio* covid use_label_element "Yes" "No" "Medically exempt"]
We take the wellbeing of our guests very seriously. Should we have any concerns about your health or wellbeing whilst participating in our online programme or as part of one of our holidays, we request that you can please provide us with an emergency contact. If you are under 18 this must be your parent / guardian.
Please note - Youth Cancer Trust holidays take place from Mondays to Fridays (not weekends), all year round.
Please confirm your GP or Consultant has agreed you are fit to come on a Youth Cancer Trust holiday.
Youth Cancer Trust Holiday Activities
Activities are optional and if the applicant does not feel well enough to take part, they can either accompany the group or stay at the house. Activities can include horse riding, go karting, water sports, sailing amongst others
Are any activities to be avoided?
Online Support Application
Referral status --- Self-referral Referred by health care service
Youth Cancer Trust run a secure Facebook group for our guests. If you would like to be added to the Facebook group, please add your Facebook profile or Facebook email address below
If you are under 18, please ask your parent / guardian to sign to give their permission for you to access our Facebook group.
Activities and Support
What activities and support are you interested in?
We are open to your ideas and suggestions and will try our best to make them happen where possible. Please use the box below to tell us any ideas for activities/ support you would like to see included.
Terms and Conditions
Unless specifically stated, the online activity and support programme, and secure Facebook group is for Youth Cancer Trust guests only.
The term 'guest' refers to anyone meeting our criteria:
'young people aged 14 to 30 living with cancer or any malignant disease from anywhere in the UK and Irish Republic or who are patients of any UK hospital. You can also join our program if you have been in remission for up to 5 years, or are living with the late effects of having had cancer as a teenager.'
At our discretion, we are also currently accepting applicants meeting the above criteria who are over 30 years of age.
All guests participating in our online programme agree to at all times treat peers and staff respectfully and courteously, or may be asked to leave the programme.
All content in the secure group including guest’s comments, photos, zoom recordings and zoom links are strictly to remain within the group only and not to be shared publicly, unless permission has been granted from the individual or group moderators.
Youth Cancer Trust will not tolerate any bullying or intimidating behaviour and reserve the right to remove and block anyone from accessing the secure group and activities if they do not adhere to the above conditions.
Should guests experience any bullying from peers or they have any concerns / grievances please report to one of the group moderators immediately.
Guests participating in physical activities hosted by Youth Cancer Trust must seek advice / permission from their GP first if they are not currently physically active.
Thank you for taking the time to complete this form
The completion of this form is a legal requirement for Youth Cancer Trust. Please Note Youth Cancer Trust does not disclose personal data to third parties. Personal data is kept confidential and only used for the purposes of arranging your holiday and keeping in touch with you. If you have any questions relating to this form or Youth Cancer Trust holidays please telephone 01202 763591 and we will be happy to help.
By submitting this form, you are adhering to our terms and conditions and if you are under 18 you are confirming that you have permission from a parent or guardian that you are allowed to join the online community. Your details will be kept safe in line with our strict data protection policy.
If you have anything you would like to add, please do so here. PLEASE REMEMBER TO CLICK 'SUBMIT' TO SEND YOUR COMPLETED FORM.