Application Form

Apply for your very own
funded day out

Day Out Application Form

In order to understand your needs and help to provide the best day possible for you and your family we need to ask a few questions! The button below will begin the application process and should take approximately 15 minutes to complete all seven parts. We do not share the information you provide with anybody else.

Currently, we are only able to help those located in Sussex and apologise to everybody situated outside this region. In the future we hope to expand our operation so we are able to bring a smile to more and more people, thank you for your understanding.

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Jane's Wish is a registered charity for tax purposes, HMRC ref. EW62110