Elementor Page #540 – KD Foundation

KD Foundation

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Applicant Details

Please provide contact details for the person completing this application.

Full Name *

Date of Birth *

Phone *

Email Address *

Current Residential Address

Preferred contact method

Relationship to the member affected by illness *

Emergency contact name and phone number *

Family Details

Family / Household Details

Tell us who would stay at the property and whether everyone can stay safely without KDF providing care or supervision.

Number of adults staying *

Number of children staying

Names and ages of all guests *

Family details, dependants, or caring responsbilities

Can all guests stay safely without KDF providing care or supervision?

Accommodation Request

Nominate the dates you would like to use the Sydney accommodation.

Preferred property

Preferred arrival date *

Number of days requestedBooking must be at least 2 weeks in advance. Maximum stay period is 4 days.

Flexible date options

Has the family stayed with KDF Foundation before ?

Reason for requesting the stay *

Special timing considerationsTreatment dates, school holidays, recovery periods, or family availability

Medical Requirement

Mandatory Medical Requirement

A doctor's certificate, medical letter, or medical support form is required for all applications. KDF Foundation does not require detailed private medical records, but it does require enough information to confirm that the application meets the charitable purpose of the accommodation program.

Name of person affected by illness

Relationship to applicant *

General category

Short explanation of medical cirumstances *

Doctor's certificate / medical letter uploadMedical certificate, hospital letter, GP letter, or support letter. File names are saved in this mock app; files are not uploaded to a server.

No file chosen

Doctor or medical provider name *

Clinic / hospital name *

Date of certificate or letter *

Optional : I consent to KDF contacting the doctor or medical provider only if clarification is required.

Financial Hardship

Mandatory Financial Hardship Requirement

Financial hardship is a mandatory eligibility requirement. This information is collected only to assess charitable eligibility and will be reviewed respectfully and confidentially.

Does the family currently experience financial hardship?

Does the family consider itself at or below the poverty line? *

Approximate Annual household income range *

Numder of dependants

Relevant hardship factors *Medical costsLoss of incomeReduced work capacityCentrelink or government supportHousing stressTravel costs for treatmentFamily crisisOther hardship

Short written explanation of hardship *

Supporting document uploadCentrelink statement, concession card, income statement, hardship letter, or other evidence. Fiile names are saved in this mock app; files aer not uploaded to a server.

No file chosen

Suitability

Property Suitability and Accessibility Disclosure

The property does not include accessible facilities. Applicants should consider whether the accommodation is suitable if any guest requires step-free access, wheelchair access, accessible bathrooms, hoists, specialist equipment, or assisted-care facilities.

This is a property limitation and suitability disclosure. KD Foundation will assess applications fairly and without unlawful discrimination.

Required acknowledgements *I understand the accommodation is short-term accommodation only.I understand KD Foundation does not provide care, supervision, medical support, personal support, nursing, respite care, transport, food, or disability services.I understand the property does not include accessible facilities.I understand the property may not be suitable if any guest requires step-free access, wheelchair access, accessible bathrooms, hoists, specialist equipment, or assisted-care facilities.I confirm that all guests can safely use the accommodation without KDF providing support services.I understand KDF may decline an application if the property is not suitable for the family's needs.

Waiver

Liability Waiver / Property Use Agreement

This draft wording is a placeholder for review by an Australian solicitor before use. It is not final legal advice.

The following Property Use Agreement and Liability Waiver should be reviewed and adapted by an Australian lawyer before KDF Foundation relies on it.

Free short-term stay - Accommodation is provided free of charge and is temporary, short-term holiday accommodation only.

Accommodation only - KDF Foundation is not a hotel, hospital, respite provider, disability service provider, medical provider, crisis accommodation provider, or supervised care provider.

Risk of injury or death - Guests acknowledge that use of any property may involve risks, including slips, trips, falls, illness, accident, serious injury, permanent injury, or death. Guests accept responsibility for deciding whether the property is suitable and safe for their family before and during the stay.

Release and waiver - To the maximum extent permitted by Australian law, guests release KDF Foundation, its officers, volunteers, employees, agents, and property owners from liability for loss, injury, illness, serious injury, death, property damage, or expense arising from the stay, except where liability cannot lawfully be excluded.

Australian Consumer Law - Nothing in this agreement excludes, restricts, or modifies any consumer guarantee, statutory right, duty, or liability that cannot be excluded under Australian Consumer Law or other applicable Australian laws.

Guest responsibility - Guests are responsible for their own medical needs, medication, transport, food, personal care, supervision of children, and emergency arrangements. Children must be supervised by a responsible adult at all times.

Safety and suitability - Guests must disclose any medical, mobility, behavioural, environmental, or other safety concern that may affect suitability before the stay. Guests must contact emergency services directly in an emergency.

Property rules - Guests must follow house rules and may be responsible for damage caused by misuse, negligence, or breach of those rules.

Cancellation or refusal - KDF may cancel or refuse a stay if the property is unsuitable, unsafe, unavailable, or if information provided is incomplete or inaccurate.

No reliance on KDF support - Guests must not rely on KDF Foundation to provide monitoring, supervision, clinical judgment, assisted care, emergency response, transport, meals, medication support, or disability access equipment.

I have read and agree to the Property Use Agreement and Liability Waiver. *

Declarations

Declarations and Consent

Please confirm the declarations before submitting the application.

Required declarations *I confirm the information provided is true and correct.I confirm the application includes both mandatory requirements: medical support and financial hardship.I consent to KDF Foundation reviewing the information for eligibility assessment.I understand KDF may request further information.I understand submitting this form does not guarantee approval.I understand approval is subject to eligibility, availability, property suitability, and KD Foundation discretion.I understand KD Foundation may decline an application where the accommodation is unsuitable or unavailable.I agree to the privacy collection statement.

Review

Review and Submit

Please review the key details before submitting. You can move through the form freely, but submission is blocked until all required fields are complete.

Patient Name - {name-2}

Contact - {name-1}

Family members staying - {number-1} adults, {number-2} kids

Requested Stay - {number-3}

Medical document uploaded - {upload-1}

Financial hardship document uploaded - {upload-2}

Suitability acknowledgements - {checkbox-3}

Liability waiver Not accepted - {checkbox-4}

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Australian charity supporting families with seriously ill children by providing free accommodation to promote hope and statbility.

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