Early Help Activities Sign Up Form

This form is for the Greater Manchester Violence Reduction Units targeted referrals programme, focusing on mentoring and Doorstep Sports activities. We aim to work closely with the referrals to encourage them to build positive outcomes and create beneficial pathways through the power of sport. Referrals will be expected to attend at least 5 of the sessions mentioned in the form, showing good engagement in the activities on offer, prior to them receiving a 12 month membership in to one of our centres. We will also ask referrals to attend a progress check in one of our centres every 4 weeks with one of our Your Trust staff to ensure the referral is getting the best out of their memberships.

Type of Activities(Required)
Who has referred the child/young person?(Required)
If 'other' please detail who here:
Child/Young Person's Name(Required)
First Last
Child/Young Person's Address(Required)
Street Address Address Line 2 City Post Code
Child/Young Person's Date of Birth(Required)
DD slash MM slash YYYY
Child/Young Person's Ethnicity(Required)
If 'other ethnic groups' please detail here
Contact Number (Parent/Guardian if member is under 16)(Required)
Does the child/young person pose any risks to the public?(Required)
If 'yes' please detail any concerns
Why are you getting the child/young person access to activities? (further details)(Required)
What does the child/young person hope to gain from the activities?(Required)
What specialist/wrap around support are your service providing for the child/young person who is being referred?(Required)
Is the child/young person involved with the police?(Required)
Does the child/young person have any outstanding convictions?(Required)
If 'yes' please detail any concerns
Email (Early Help Professional)(Required)
Comments
This field is for validation purposes and should be left unchanged.

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Early Help Activities Sign Up Form