Protected: Expression of Interest (EOI) form



This form will help us determine the suitability of the programme for your child and does not guarantee a place at the Breathe Magic Intensive Therapy Programme. We will aim to be back in touch with you within two weeks of receiving the form.


If you require any help completing this form or would like to receive it in a different format please contact us via email on info@breatheahr.org or telephone 020 3290 2013.

Please fill in our expression of interest form here. Fields marked with * are mandatory. If you do not fill them in you might receive an error message.


Personal Details

*Child’s name:

*Child’s Date of Birth:  

*Gender: (select from dropdown)

*Postcode:
*Country:

*Parent’s name:

*Email:
*Telephone:
Telephone 2:

Eligibility
The following are our main eligibility criteria for young people attending the Breathe Magic Camps. Please tick as appropriate to confirm this applies to your child. Please note that not meeting these criteria does NOT automatically exclude your child from the programme. We will always undertake a personalised assessment for eligibility.

Young person with hemiplegia, or one-sided weakness
(caused by Cerebral Palsy or Acquired Brain Injury)
Aged 7-19 years at start of camp 2
Able to remember sequences of 3-4 steps 3
Can cooperate to perform tasks in a group setting
Attending mainstream school

How did you hear about the programme? (select from dropdown)

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Yes, please sign me up.

By submitting this form you are consenting to our privacy policy.

Article written by Annegret
09 Jul 2019