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Child Drowning Support Fund Application Form

Please complete and submit the form below to apply for a Child Drowning Support Fund grant. This form may be submitted by a health or community professional with the consent of the family. Please specify this in the form.

All applications will be considered. If we have any queries or require further information, we will contact you to discuss this before your application is assessed. You will be notified of the outcome of your application no more than four weeks after submission.

Please advise us in your application if funding is urgently required, as we may be able to expedite the approval process.

Name of child impacted by non-fatal drowning incident:

Date of birth of child:

DayMonthYear

Name of applicant:

Relationship to child:

Postal address:

Suburb:

State:

Postcode:

Phone Number:

Email Address:

Please tell us about your child's drowning incident:

Please provide a brief description of the medical/hospital care received at the time of their drowning and subsequent medical care that has been required:

Please describe the resource, services or support requested:

Approximate value of the resource, services or support requested:

(an exact figure is not required, we will finalise this with you during the application process)

How will this funding make a difference for your child and family?:

Any other comments?:

I agree that I have not received funding for the requested resource, service or support from another organisation or entity

I agree to provide Royal Life Saving WA with written quotes and/or tax receipts for the requested items as required

(Optional): If you have any existing quotes or documentation from suppliers, or receipts of items already paid for, please upload them here: