Apply for a Grant

Application form

    PERSONAL DETAILS







    INJURY DETAILS









    EQUIPMENT / GRANT REQUEST







    yesno



    APPLICATION SUPPORT

    Please provide the contact details of either your consultant, occupational therapist, case manager, physiotherapist, care manager or if appropriate, a relative who we can contact to verify that the equipment requested is suitable








    I confirm the above is true and accurate



    yesno


    yesno


    FINANCIAL



    yesno



    yesno


    yesno


    yesno


    yesno


    Notes

    Please complete the application form to apply for a grant from Regain.

    Accompanying letters should be e-mailed to grants@regainsportscharity.com