Grant Application Form

Olivia Mae Foundation grants (up to £100) are for expenses associated with a child in hospital care

About you
Name*
Address*
Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country
Contact Phone Number*
Email*
Relationship to Child*
Child's Name*
Child's Address (if different)
Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country
Patient number (MRN)
Hospital Contact (medical staff or social worker)
Name*
Contact Phone Number*
Role in Child's Care*
Grant Details
How Much?*
Purpose of Grant*
Paypal Reference or Cheque*

How we can help you

The foundation will help to support families who have a child in long term hospital care.

Find out about the 3 ways that we can help.

Challenge yourself, be as wild and wacky as you like, shave your head or climb a mountain, cycle the country or stay quiet for a day. Whatever will get your friends and family digging deep to sponsor you.

The story so far

Since 2013, you've been fundraising through a multitude of ways including sponsored events and charity balls, raising over £50,000!

Helping families when a child is ill in hospital

how you can help

About you

Hospital Contact (medical staff or social worker)

Grant Details

How we can help you

How you can help

The story so far