Please complete this form and return via email to to confirm that you wish to receive further consignments of Activity Boxes from Dragonfly Cancer Trust. The information you provide will be used to demonstrate the impact of our service and help us to improve the quality, contents and delivery of our Activity Boxes. In order for us to do this we rely on your feedback and if you are willing to share photographs of completed activities with Dragonfly Cancer Trust and outline the impact these activities have on the young patients you support, please feel free to add comments and photographs to this email.

Thank you for taking the time to complete this form.