Book Your Breakaway 2022

Title—Please choose an option—MrMsMiss
First name
Surname
Date of birth
Home address
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Postcode
Country
Email address
Phone number

Parent's Details

Parent’s name
Parent’s contact number
I confirm I have discussed this with my parent(s)/carer(s) and have their approval

Your Consultant's Details

Consultant's name
Consultant's contact number
Consultant's email address
I give my permission for you to contact my consultant to confirm I am physically and medically fit to take part in CLDF Breakaway

Tell Us How You Want To Hear From Us

Children’s Liver Disease Foundation 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.

What would you like to hear from us about and how?

Please note:
1. We don’t send much post so if you only choose one option email would be best.
2. We’ll update all contact preferences on our systems within 21 days of receiving your request.

CLDF support services, family/young people events and general information and updates, including our Liver Life magazineBy postBy emailBy phone (a call from a member of the CLDF team)By text/SMS
CLDF Fundraising events and activitiesBy postBy emailBy phone (a call from a member of the CLDF team)By text/SMS
Alternatively, if you no longer wish to hear from CLDF at all please tick this boxDon't contact

Your details are safe with us

We'll always store your personal details securely. We'll use them to provide the service 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 see our Privacy Policy. It's important that you read this policy to understand what information we hold, how we use it and what your rights are.

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