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Childs Name

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Consent to share information

Yes

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Consent to store information

Yes

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Yes

Help The Harley Jae Trust!

The Harley Jae Trust fund entirely on the genoristy of public donations and social media plays a big part in helping us raise much needed funds.

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Consent to social

Yes

We will not share any personal information including surname, address, contact details, your child's diagnosis/current medical needs or any other information in which could identify you and your family.

Parent/guardian Email Address

Parent/guardian Signature

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Parent/guardian Name

Date

Referring your a child to The Harley Jae Trust

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Can you confirm whether you give consent for us to store your personal information in line with the General Data Protection Regulations?

Can you confirm that you are happy for us to contact you via the above details for further details regarding this referral if needed?

Help The Harley Jae Trust!

Can you confirm whether you give consent to us share basic details including your child's first name of this donation on our social media?

Donate to The Harley Jae Trust today!