Your Details

We will use the details you provide to send your Brainy Bag and ensure the contents are appropriate for your child. If you are happy to share any health information with us, we will use this to provide relevant information and support, monitor our services and make improvements in future.

Title

First name

Last name

Email address

Phone number

Please note: Brainy Bags are available for all children and young people with a brain tumour diagnosis within the United Kingdom only.

Postcode

Address line 1

Address line 2

Town / City

County

What is your relationship to the child with a brain tumour?

I am their

How did you hear about our Brainy Bag?

Please tell us how you heard about our Brainy Bag

The child's details

Child's first name

Child's last name

Gender

MaleFemaleOther

Child's date of birth

Child's brain tumour type (if known)

Other tumour type

Child's tumour grade (if known)

Low Grade (1-2)High Grade (3-4)

Child's date of diagnosis

Recency of your child's diagnosis

Within the last 2 weeksWithin the last 4 weeksMore than 4 weeks ago

Where is your child's primary hospital?

Keeping in Touch

We'll send your child's Brainy Bag shortly, however we'd also love to keep you up-to-date on how we are making a difference, this will include information about research, support services and how you can get involved, for example by fundraising, campaigning or volunteering.

Can we keep you up to date via email?

YesNo

You can change your contact preferences at any time by emailing enquiries@thebraintumourcharity.org or calling 01252 237792.

Your details are held on our secure database and we promise never to share them with any other organisation for their marketing purposes. You can find out more in our Privacy Policy.