Respite Care Grant Application form

This online application form allows you to apply for a respite care grant from Oxford Branch of Parkinson’s UK. A copy of your application will be emailed to you for your records, and the application will be passed to our Scheme Coordinator.

You can find full details of how we handle and store your personal information here on the website of our national charity Parkinson’s UK.

To apply:

Carefully read the conditions and other information on this page.
Fill in all the information requested on this form.
Finally, if you are happy to proceed, submit your application. Full instructions will appear at the bottom of the page when you have completed all the information.

The person with Parkinson’s who will receive the care

Please fill in your details

Name Address including postcode Name of care agency or care provider

By submitting this application form, I/we confirm that:

I/We have arranged respite care for the above named person and I/we acknowledge that I/we are responsible for the selection of the care provider and the care to be provided by them, and for paying for all costs incurred by or with the care provider.

I /We will provide Parkinson’s UK copies of invoices for this care via email to treasurer@oxfordparkinsons.org.uk as incurred up to the maximum grant amount of £1000 per calendar year. Payment of the grant will be made by way of reimbursement of these invoices (up to the maximum of £1000) and is subject in each case to receipt and review by the Oxford Branch of copy invoices.

Payment of any grant amount is subject to the branch having sufficient funds available at the time of payment.
I/We have provided below my bank account details to which payment of the grant should be made and a valid email address to enable the branch to contact me with any queries with regard to this application or any invoice or payment.

IMPORTANTDISCLAIMER OF LIABILITY - PLEASE READ

I/we acknowledge that:

This care has not been organised by Parkinson’s UK (company number 00948776) or its Oxford branch and nor have they given me any advice or made any recommendation regarding this care or the selection of the care provider.
Payment of all or any part of the grant is not an endorsement or recommendation by Parkinson’s UK (or its Oxford branch) of the care provided or the care provider or its or their suitability to me/us or any other person. Parkinson’s UK (including its Oxford branch) has no liability for the care provider or for any care provider.

Applicant and payment details

In this section, please provide information about the person who is making this application. You may be the person with Parkinson’s, or a supporter who is helping to arrange care. We need your email address to stay in contact, and your bank details so that we can make payments.

Name of applicant Bank name Account name as it appears on cheques and statements Bank sort code Bank account number Email address

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You can find full details of how we handle and store your personal information here on the website of our national charity Parkinson’s UK.

By clicking this "submit" button, you confirm that you have read and agree to the conditions and privacy policy listed above.

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