Become a Change Maker

We are so pleased that you've decided to become one of Contact's Change Makers.

Please fill in this form so that we can learn a little more about you. 

We will look after your details in accordance with our data protection policy.

Remember to press SUBMIT at the end. 

Enter your details

Please tell us a bit about you  

 

About your children

The next question asks about your child's age and diagnosis, if they have one, and any additional information about your child’s needs or diagnoses, if you wish.

If you have more than one disabled child, you can complete the questions for two additional children. If not, simply skip to the end of the form and press submit.

Child 1

Child 2

Child 3