Thank you for your interest.

Due to consent purposes, this form should be completed by a parent or guardian. Completing this form is the first step in expressing your interest to attend The Breathe Magic Intensive Therapy Programme. Once completed, a member of the team will be in contact. They will be able to provide guidance around the next steps in signing up to attend the programme as well as answer any questions you may have about the programme.

Please note, if you are a clinician looking to make a referral please get in touch with us directly or request that the parent/guardian completes the below form. We look forward to hearing from you.

Personal Details

Fields marked with * are mandatory.

*Child’s Full Name: *Child's Date of Birth: *Child's Gender: (select from dropdown) *Parent/Guardian's Full Name: *Email: Home Phone Number:
*Mobile Phone Number: *Flat / House Number & Street: *City: *Postcode: *Country:
 

Eligibility

The following are our main eligibility criteria for young people attending Breathe Magic Camps, please tick as appropriate to confirm this applies to your child. Please be assured that a ‘no’ to any criterion doesn’t necessarily mean your child is ineligible. The answers you give should be your best estimate and will be used to inform the conversation with our Clinical Leads to inform whether the programme will be suitable for your child.

*Young person with hemiplegia - or one-sided weakness - caused by Cerebral Palsy or Acquired Brain Injury: (select from dropdown) *Aged 7-19 years at start of camp: (select from dropdown) *Able to remember sequences of 3-4 steps: (select from dropdown) *Can cooperate and attend to perform tasks in a group setting: (select from dropdown) *Able to learn at mainstream (or equivalent) level: (select from dropdown) *As the programme is delivered in English, the young person has a sufficient level of English language to understand instruction and communicate with staff: (select from dropdown) To determine if your child is clinically eligible to join our programme, we will require them to attend an in-person taster workshop. Please confirm if you can attend our upcoming workshop date - Saturday 2nd November 2024 (PM) at Sea Containers London.
Yes, my child can attend.
Does your child have any other diagnoses, medical conditions, or allergies? If yes, please list them: Has your child attended the Breathe Magic Intensive Therapy Programme before? (select from dropdown)
Please let us know any further details relevant to your answers:

Programme Dates and Availability

Please note, we are a London-based organisation and our programme is generally delivered in London. We have families joining us each year from all across the UK (and sometimes even abroad!) and we are experienced in supporting families to join the programme who may live further afield.

If your child is eligible, would you be able to attend the programme on the following dates?
28th Jul - 8th Aug 2025, London
Would you be interested in future dates?
Yes, please let me know.

Funding

The team at Breathe work hard all year round to secure funding from NHS Commissioners, businesses, grant funders and individuals to cover as much of the cost of each child’s place as possible. This means where possible, we offer all children taking part in the programme a subsidised place (subject to change). Please indicate how you plan to secure funding for your child’s place (tick as appropriate):
We plan to self-fund in full.
We plan to self-fund and apply for the subsidised price.
We are planning to fundraise for our child’s place.
We have access to case management/other statutory funds.
How did you hear about the programme? (select from dropdown) If other, please specify:
Would you like to sign up to our newsletter?
Yes, please sign me up.
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