Referral

Beyond the Horizon Enquiry Form

Thank you for your enquiry about our projects. Please complete the form below and we will be in contact to let you know if we can support you and your child.
If your enquiry is not about how we can support an individual child or family but about something else please email admin@beyondthehorizon.org.uk or call our office on 0121 444 5454.

Beyond the Horizon (BTH) is committed to complying with the terms of the UK General Data Protection Regulation (GDPR), and to the responsible and secure use of your personal data. BTH has a legitimate interest in processing personal data in order to provide therapy services. For further details about what personal information Beyond the Horizon collects and holds, why we collect this data, how long it is kept and your rights over your personal data please refer to our Privacy Notices which can be found on our website (www.beyondthehorizon.org.uk) and displayed in our premises. BTH is registered with the Information Commissioner’s Office (ICO), reference ZA126454. The Beyond the Horizon Data Protection Officer is the CEO. The BTH Complaints Policy is available on request.

Client/your details

Surname of child*

First Name of child*

Your name*

Your role*

Other

Contact email address*

Contact phone number*

I want to refer a child/young person because they have experienced
(please select all that apply):*

Bereavement*

Separation or divorce of parents*

Domestic Abuse in the home*

Age of child*

Ethnicity of child

The projects I am interested in are:

BEAR (family support for a bereavement within the last 6 months)*

One to one therapy for a child/young person*

Therapeutic parent support phone sessions*

Child Parent Relationship Therapy Group (parents/carers only)*

Other - please specify

Is this child/young person registered at a Birmingham school or college?*

We have a specific Sutton project, is the person you are enquiring about living in Sutton or attending a Sutton school?

Name of the area of Birmingham the child lives in*

Is there any social care involvement?

Early Help Support Worker*

Child in Need Plan*

Child Protection Plan*

Child In Care*

Other - please specify*

Other information

Is an interpreter needed?*

Is there an ongoing court case regarding a Child Arrangements Order, e.g. residency or contact?*

Is there anything else you feel we should know? (Please do not include personal data here)

Today’s date is: *