Play Therapy Pod Application Form

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Child’s details

Newlife defines a significant disability as being a physical and/or cognitive impairment which affects activities of daily living. A life-threatening condition should be defined as a condition whereby the next period of ill health would make it likely that life- sustaining intervention would be needed. Newlife defines a life-limiting condition as a condition that results in a shortened life expectancy, as opposed to having limited life experiences that could affect quality of life. A terminal illness is generally defined as not being expected to live longer than six months and/or a person who has an advanced care plan to meet end of life care needs.

If so, please record the extent to which these are controlled and if there are any known triggers for these seizures - such as flashing/bright lights, loud noises etc. Please note that if we believe there to be an associated risk we will remove items from The Play Therapy Pod before provision

(Please note that if we believe there to be an associated risk we will remove items from the Play Therapy Pod before provision)

Think about your child’s physical, social & emotional, communication and Cognitive development.

We recognise that all children’s development is unique to them, and children may need toys that are better suited to their stage not their chronological age. As such we will happily accept applications for any pods that don’t exceed your child’s age.

If you need support in identifying the type of pod that would offer the most support, please don’t hesitate to contact Newlife’s Child and Family Support Team on 01543 468 888 option 2 or liaise with your local professional to help identify ways to use the toys in line with any existing developmental plans which you may have.

Visual Toys - encourage visual focus, coordination and stimulation.
Interactive Toys - demonstrate cause and effect and encourage interactive play.
Auditory Toys - make noises and encourage auditory stimulation
Tactile Toys - will stimulate touch and encourage associated motor functions

** Please select up to 2 Play Therapy Pods**

Sensory Pods – specially designed to mentally stimulate one or more of a child’s senses for very early development.
Adventure Pods – includes themed toys, with a fun range of interactive toys available for your child to enjoy.
Discovery Pods – includes visual, interactive and sensory toys, which could include instruments, light up and plushies.
Explorer Pods – suitable for 5 years plus, for children to explore sounds, textures and visual exploration.
Child Demographic Information. Please tick the box that you feel is most appropriate:

Parent/Primary Carer details

Professional Details

Terms and Conditions

  1. All the information given in this application process is up to date to the best of your knowledge.
  2. Newlife is a Charity and while we will try to help as many families as possible there may be occasions that we are unable to help.
  3. Please remember that the equipment provided should be used for the intended child/young person.
  4. The Equipment may be provided to you as a charitable act. We will therefore only be responsible for any loss or damage that you suffer in connection with this agreement, to the extent that we are able to claim for such loss or damage under our insurance.
  5. Following delivery of Play Therapy Pod, we will contact you to gather feedback on the service you received and the difference made by the use of the toys.
  6. Do not use the items within the Play Therapy Pod until you have read all the instructions included in the pod and to agree to always follow all instructions and recommendations provided to you by us, the manufacturer or supplier of the items included in the Pod. The information supplied covers health and safety aspects and guidance for looking after the contents during the loan period.
  7. You will be responsible for the Pod for 12 weeks, once loaned to you by Newlife. Within this 12 week period, if you no longer need the Pod, we need you to tell us as soon as possible so we can arrange for it to be collected from your home. This will usually be within three working days, but we will agree a suitable date for this collection with you. If you need it for longer than 12 weeks we will liaise with you regarding an extension or change of provision.
  8. Tell us if the Pod and its contents become unsuitable for your child to use, due to changes in need or circumstances.
  9. The Play Therapy Pod and its contents remains the property of Newlife, and we retain the right to recall the pod and its contents. This notice will normally be given in writing.
  10. Take all reasonable steps to ensure that the Pod and contents are properly looked after. If the contents are lost, stolen or damaged whilst in your possession then you must let us know as soon as possible. We will arrange for the Pod and contents to be inspected and if possible replaced.
  11. Following the loan of a play therapy pod, we will arrange collection on a date and time that is convenient for you. If we are unable to arrange this and as a result the Play Theory pod is not returned., All further loans within the your application will be terminated .

Family Declaration

It’s important, that we can share some basic information. This is common with most charities who are highly dependent on the public to help them meet the needs of children and their families.
In these cases Newlife will remain the Data Controller but will simply share your data for the purpose of data analysis only. In all cases we will use a non-disclosure agreement to ensure that the third party does not misuse any data provided.
We will not share your data and you can unsubscribe at any time. If you would like to update or change the way you hear from us, please contact Newlife on 01543 462777 or via email at