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Please enter the Young Persons details in this section
Date of Referral
Forename*
Surname*
Preferred known as
Preferred Pronouns
Date of Birth*
Address line 1
Address line 2
Town
County
Postcode
Ethnic Group
Gender
Do you follow any religious or faith based practices that we should be aware of?
If yes, please detail here:
Is the young person known to social care?*
If yes, please provide contact details (name, phone number and email)
Medical/Health Information
Do we need to know about any mental health conditions, sensory issues or triggers, including reasonable adjustments? (confirm if diagnosed or undiagnosed)
Mental Health Conditions, Sensory Issues and Triggers
Do we need to know about any allergies, dietary requirements or medical conditions, including medication? (confirm if diagnosed or undiagnosed)*
Do you have any Special Educational Needs or Disabilities (SEND), such as learning, communication, behavioural or physical needs that we should be aware of in order to support you?*
Allergies, dietary requirements or medical conditions*
Is the young person being referred 5 years old or older?
About the young person
Likes, Hobbies, Interests
Dislikes
What would you like to gain by joining Trust Links?
Education
Are you currently enrolled in a school?
Education Status
What school are you registered with?
School Contact
How often are you attending school?
If part time, how many hours per week are you attending school?
Have you previously been in full time, mainstream education?
Have you previously been in alternative education services such as a pupil referral unit or a part time timetable?
Have you ever been excluded from education?
Do you have an ISP (Individual Support Plan) ECHP (Education Health Care Plan), or any other support plans in place?
If you do not have any educational support plans in place are you undergoing any or do you have any concerns about additional needs?
if yes, please detail
Parent/Guardian Details
Parent/Guardian 1 Name*
Address (if different from Young Person)*
Phone Number*
Email Address
Parent/Guardian 2 Name
Address (if different)
Phone Number
Do you give permission for your child/young person to make their own way to and from our sites?
Which project are you referring this young person to?
Youth Links
Thundersley Youth or Gunny Youth
Learning Together
Dig it Youth
Bouldering Together
17-25's Social Group
Are you a Parent/Guardian/Relative/Professional/Other?
Name of Referrer
Referrer Job Title (if applicable)
Referrer Organisation (if applicable)
Telephone Number (Referrer)
Email Address (Referrer)
What is the reason for your referral?
Parental/Guardian Permission
I agree to inform Trust Links if any of the information provided above changes