Name & Details of Parent/Carer/Legal Guardian

Name(Required)
Relationship to child(Required)

Address

Name of Child or Young Person with a Liver Condition (aged 0 - 24)

Name(Required)
DD slash MM slash YYYY

Child's/Young Person's Health Information

DD slash MM slash YYYY

Details of other Children/Young People in the Family

Please give us your consent

Consent 1(Required)
To be completed by Parent/Carer/Legal Guardian of Young Person with a Liver Condition aged 13-15 For any young person aged 13-15 we also request that you give us your consent for CLDF's Young People's Team to contact your child and for them to receive our information.
Consent 1
DD slash MM slash YYYY

Tell us how you want to hear from us

Children's Liver Disease Foundation (CLDF) would love to keep in touch with you about our vital work. By contacting you in the way you choose, we can be more cost effective in our communications and marketing activity. Please let us know what you would like to hear from us about and how by ticking the box(es) below. You can choose all these options or just one or two of them-it's up to you. *Please note you will only ever be contacted by phone by a member of the CLDF team.

Parent/Carer/Legal Guardian

CLDF Support Services and general information and updates, including our Liver Life magazine.
CLDF Fundraising news & opportunities

Young Person with a Liver Condition aged 13-15

CLDF Support Services and general information and updates, including our Liver Life magazine.
CLDF Fundraising news & opportunities

Your details are safe with us

We'll always store your personal details securely. We'll use them to provide the service(s) that you have requested and communicate with you in the way(s) you have agreed to. Your details may also be used for analysis purposes, to help us provide the best possible service. We won't sell your details to anyone else and we'll only share them with suppliers working on our behalf, or if required to do so by law. For full details please CLICK HERE to view CLDF's Privacy Notice. We suggest that you read this Privacy Notice to understand what information we hold, how we use it and what your rights are.
How would you like to receive it?