Application Form | Youth Cancer Trust

Complete the full application form.

Please complete the application form and then expect a call back from us within 2 weeks.

During the phone call we will establish what your needs and wishes are:

  • Sign up for online community only
  • Sign up for holiday
  • Sign up for holiday and online community
  • Signpost to other services as we can’t provide you with what you need

Things you need to know

  • We offer both holidays and online support. You can apply for either or both.
  • We call our young people ‘ GUESTS’ .
  • Guests are able to bring a COMPANION with them on holiday (sibling, friend, partner of a similar age) they are called COMPANION guests.
  • We provide online support for GUESTS only
  • Staff are not medically trained
  • We have confidentiality and safeguarding policies
  • We operate flexibly in office hours 8.30 – 5. 30. When there is an evening or weekend activity we work at the hours specific on the event.

    Application Form

    Who’s completing the form:

    Guest details and information

    Personal Information

    Please upload a photo of yourself so we can recognise you if we need to collect you and so our chef knows who you are if you have any particular dietary requirements. If you are unable to upload your photo, please email it to laura@yct.org.uk

    Contact Details

    How do you prefer to be contacted

    Emergency Contact

    We take the wellbeing of our guests very seriously. Should we have any concerns about your health and wellbeing whilst participating in our online programme we request that you can please provide us with an emergency contact. If you are under 18 this must be your parent/ guardian.

    Primary Contact

    Secondary Contact

    Equal Opportunities

    Guest considers their ethnic background to be?

    Guest's Religion

    *NB if you come on holiday you may want to let us know how we can support your religious practice

    Communication Needs

    Please let us know if you have any needs that might impact on our communication with you

    Guest Health

    Information about your cancer

    For our online support please share with us any health conditions that you would like us to know about.

    If you decide to come on holiday with us you will be asked to complete a more detailed medical form.

    Criminal Convictions

    If you tick yes a member of staff will chat to you about it.

    Application Options

    Activities and online support

    What are you interested in?

    Zoom activities

    Facebook live

    Facebook posts

    Emails

    Phone or zoom

    Holiday Application

    Age

    Guest Information

    Medical Information

    Information about your cancer

    If current status in treatment, maintenance or non curative you must you will need to get your GP or Consultant or CNS to agree that you are well enough to come on holiday and provide us with the information below in case we need to take you to the GP or the hospital.

    GP

    Other conditions

    Allergies

    Asthma

    Epilepsy/seizures

    Diabetic

    Addisons or Adrenal Insufficiency

    Emergency Protocol

    Please state the protocol you follow in an emergency if you have one. (i.e if you had a seizure what do you do/ want us to do). Otherwise we will carry out standard first aid procedures.

    Physical Abilities

    Note: You need a certain level of independence or happy to receive support from your companion as we are unable to help to with physical care.

    Mental Health

    Fatigue levels and 'brain fog' or memory issues

    These are some of the commonest symptoms our guests have to manage.

    Medication

    Please note you are responsible for your medication. There is a designated medical fridge on site for medication that needs to be kept refrigerated.

    Some prescribed medicines contain substances that mean they are called controlled medicines . You will probably know if you are on these and there are some laws around how they are stored. Common examples include morphine, diamorphine, methadone, fentanyl, alfentanil, oxycodone, methylphenidate, dexamphetamine, ketamine and tapentadol.

    In order to abide by the law and to ensure safety, staff will need to store these medications in locked cabinet and staff will support you to access your locked medications.

    There are other medications /injections such as Epipens or hydrocortisone injections or Midazolam that guests may need to carry on their person.

    Please state any specific needs around taking your medication.

    Please List Your Current Medicines:

    Over the counter medications will be available for over 18’s to request as long as they complete a medical disclaimer.

    Dietary requirements and preferences

    Our chef would like to know in advance your dietary needs and preferences.

    I drink:

    Dogs

    There might be guide/ medical dogs or Laura’s therapy dog present during the holiday.

    UNDER 18's

    I agree to (please tick):

    If you are actively under the care of a hospital medical team or have significant health conditions, we do require to discuss with you whether you are well enough to attend a residential stay. Please note that we are not set up to provide medical care to individuals but can respond to emergencies at our local hospital in Dorchester – Dorset County Hospital. We also have a local GP Practice in Puddletown.

    It is you’re the applicant or parent/carer responsibility to check with the GP or health professional that you are well enough to attend a holiday. We understand that sometimes situations change and ask that if you can no longer attend your booked holiday, you please inform us asap so we can give the holiday to someone else.

    OVER 18's

    I agree to (please tick):

    If you are actively under the care of a hospital medical team or have significant health conditions, we do require to discuss with you whether you are well enough to attend a residential stay. Please note that we are not set up to provide medical care to individuals but can respond to emergencies at our local hospital in Dorchester – Dorset County Hospital. We also have a local GP Practice in Puddletown.

    It is you’re the applicant or parent/carer responsibility to check with the GP or health professional that you are well enough to attend a holiday. We understand that sometimes situations change and ask that if you can no longer attend your booked holiday, you please inform us asap so we can give the holiday to someone else.

    Consent regarding photos and filming with Over 18’s will be asked on arrival.

    Companion

    Who’s completing the form:

    Guest details and information

    Personal Information

    Please upload a photo of yourself so we can recognise you if we need to collect you and so our chef knows who you are if you have any particular dietary requirements. If you are unable to upload your photo, please email it to laura@yct.org.uk

    Contact Details

    How do you prefer to be contacted

    Emergency Contact

    We take the wellbeing of our guests very seriously. Should we have any concerns about your health and wellbeing whilst participating in our online programme we request that you can please provide us with an emergency contact. If you are under 18 this must be your parent/ guardian.

    Primary Contact

    Secondary Contact

    Equal Opportunities

    Companion considers their ethnic background to be?

    Companion's Religion

    *NB if you come on holiday you may want to let us know how we can support your religious practice

    Communication Needs

    Please let us know if you have any needs that might impact on our communication with you

    Criminal Convictions

    If you tick yes a member of staff will chat to you about it.

    Age

    Companion Information

    Medical Information

    GP

    Other conditions

    Allergies

    Asthma

    Epilepsy/seizures

    Diabetic

    Physical Abilities

    Mental Health

    Fatigue levels and 'brain fog' or memory issues

    These are some of the commonest symptoms our guests have to manage.

    Medication

    Please note you are responsible for your medication. There is a designated medical fridge on site for medication that needs to be kept refrigerated.

    Some prescribed medicines contain substances that mean they are called controlled medicines . You will probably know if you are on these and there are some laws around how they are stored. Common examples include morphine, diamorphine, methadone, fentanyl, alfentanil, oxycodone, methylphenidate, dexamphetamine, ketamine and tapentadol.

    In order to abide by the law and to ensure safety, staff will need to store these medications in locked cabinet and staff will support you to access your locked medications.

    There are other medications /injections such as Epipens or hydrocortisone injections or Midazolam that guests may need to carry on their person.

    Please state any specific needs around taking your medication.

    Please List Your Current Medicines:

    Over the counter medications will be available for over 18’s to request as long as they complete a medical disclaimer.

    Dietary requirements and preferences

    Our chef would like to know in advance your dietary needs and preferences.

    UNDER 18s

    I agree to (please tick):

    OVER 18s

    I agree to (please tick):

    Consent regarding photos and filming with Over 18’s will be asked on arrival.

    By clicking the 'Submit' button, you are confirming that all the information on this form is correct at the time of application.