Please note, when you submit this form, you will be redirected to this page.

Family Fund Number
Main Carer's
Main Carer's Surn


Please tick if you or your partner holds a full UK a driving licence:
Child's First Name:
Child's Surname:
Child's Date of Birth (DD/MM/YYYY):
Please tick if there is another person regularly involved in supporting the additional care needs of your child and they hold a driving licence:
Contact's First Name:
Contact's Surname:
Their relationship to the child:
Child's condition and needs (to highlight more than one option, click and hold CTRL):

What difficulties do you have with transport or getting around in relation to the additional support needs of your child?
What difference would having a vehicle make to you and your child?

When you submit this form you should receive a confirmation email to the address provided above.