Bee_N_Spired

Referrer Details

Organisation Name*

Are you a school?*

Address line 1*

Address line 2

Address line 3

Town*

Postcode*

Job Title*

Title*

First Name*

Surname*

Department

Main Telephone No.*

Email address*

Bee Information

First Name*

Surname*

Preferred Name

Pronouns

Gender

Main Language

Bee Email Address

Emergency Contact Name

Emergency Telephone No.

Emergency Contact No.

Guardian/Carer Email

Date of Birth

Bee Status

Employment Status

Education Status

Additional needs?

This information is essential for safeguarding and safe delivery.
Please share any information we need to know to keep your young person safe, supported, and able to fully engage in Bee N Spired sessions.
This may include (where applicable):
• Known risks or vulnerabilities (e.g. gang affiliation, exploitation risk, absconding risk, court conditions)
• Triggers or situations that may cause distress or dysregulation
• Medical information we need to be aware of (including allergies, asthma, epilepsy, dietary requirements)
• Behavioural support needs or de-escalation strategies that work
• Safety considerations relating to peer dynamics or community risk
• Any other information that would help us support the young person appropriately
This information will be handled confidentially in line with our Safeguarding Policy and Data Protection obligations, and shared only with staff who need it to keep the young person safe.

Information Required to Support Your Young Person Safely

Programmes

Tell us some of the young persons interests