Matt's Mission Children's Charity Portal

Full Name

Relationship to Child

Phone Number

Email Address

Address

Please provide the details for each child attending the session.

Child 1

Full Name

Medical Conditions/Diagnosis

Mobility Needs

Allergies or Medical Alerts

Child 2

Full Name

Medical Conditions/Diagnosis

Mobility Needs

Allergies or Medical Alerts

Siblings

Siblings are always welcome at the Sanctuary of Smiles! Please list any attending siblings and their ages below.

Siblings

Requested Date of Visit

Preferred Time Slot

Our state-of-the-art Sensory Room is designed to be a calming, interactive space. To ensure a safe and relaxing experience, use of this room is scheduled in private or low-capacity slots.

Would you like to reserve time in the Sensory Room?

What are your child's sensory preferences? (Select all that apply)

Visual: Enjoys bubble tubes, fibre optics, and soft interactive lighting.

Auditory: Prefers soothing background music, nature sounds, or sound therapy.

Tactile: Benefits from textured walls, weighted blankets, and soft play elements.

Calming: Needs a deeply relaxing, dim, and quiet space to decompress.

Sensory Triggers to Avoid

Sudden Loud Noises

Flashing/Strobe Lights

Specific Textures/Smells

Other:

To help our team support you best during your visit, please let us know:

Does your child have a compromised immune system? (e.g., currently undergoing chemotherapy)

Are there any specific medical or behavioural support strategies our staff should be aware of?

Because many children visiting the Hub are undergoing cancer treatment and have severely weakened immune systems, a simple cold or virus can be incredibly dangerous for them.

I confirm that NO ONE in our visiting party currently has a cold, cough, runny nose, fever, or any other signs of infectious illness.

I agree that if anyone in our household develops symptoms of a cold or illness before our visit, we will contact Matt's Mission immediately to reschedule our session free of charge.

Parental Supervision & Care Responsibility (Mandatory):
I understand and agree that parents/guardians retain full, 100% responsibility for the supervision, safety, and medical care of their children at all times while at the Sanctuary of Smiles Hub.
- While Matt’s Mission staff and volunteers are here to welcome, support, and provide a magical environment, they cannot provide one-to-one childcare, medical supervision, or behavioural intervention.
- I agree to remain with my child(ren) throughout the entire duration of the session, including inside the Sensory Room.

Medical Responsibility:
I understand that while Matt’s Mission staff and volunteers are here to support and provide a safe environment, parents/guardians remain fully responsible for the medical care and supervision of their children at all times.

Photo Consent (Optional):
I give permission for Matt's Mission to take photographs/videos of my family during the session for charity promotion and social media.

Data Protection:
I agree to Matt's Mission holding this information securely in accordance with GDPR regulations, strictly to facilitate our visit.

Signed By

Date

Family Registration