Youth Organisation / School Referral Form

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This form is to be used to refer young people from and around London.

Name of the referring school/organisation *

Organisation/ School Address *

Please include your post code

Main Contact Name *

Position/Role *

Work Phone *

Mobile Phone *

Email address *

Organisation/School Safeguarding Lead (DSL) *

Work phone *

Email address *

Referral information

Name of the Young Person you are referring *

Age of the Young Person *

Why are you referring this young person to a LIFEbeat Camp? *

What are the young person’s strengths and vulnerabilities? *

What is something they love to do? *

As the referrer, what do you hope this young person will gain from attending a LIFEbeat residential?

Is there anything about the young person’s life (home/school or college/peer group) that it would be helpful for us to know so that we can support them *

Is the family receiving support from Children’s Social Care, or any other agency? Is the young person receiving support from CAMHS or any other agency? Please give relevant details that will enable us to support the young person. *

Do you have any concerns about the young person’s behaviour and how they interact with other young people and/or adults? Have there ever been concerns about violent or sexual behaviour, gang-related activity or concerns about the child being groomed or exploited? *

Finally, is there anything else you feel we should know about the young person, or their circumstances, so that we can give them the best possible experience at the Camp? *

Personal Storytelling

We introduce structured practices which invite young people to share and explore their stories in a non-coercive way. In the middle of the week, there is an evening activity called the Heart Circle- where the young people and adults gather as a whole community to hold a supportive sharing circle. Young people are invited into the circle to share a personal individual story which will help them step more fully into their lives. They will be encouraged to focus on a story which describes overcoming a challenge in their lives. There is no obligation to share, we encourage compassionate listening and respect from the whole community and there is no cross-sharing. The majority of young people and staff cherish these processes, to be able to share and connect with one another and find the Heart Circle to be a really liberating and healing activity. It is important to note with referrals that these stories are heartfelt and authentic which can occasionally be triggering for some young people who have lived through difficult and challenging times. We have lots of support available in this case and a mental health lead on hand for the duration of camp. We ask you to consider this in the referral process.

I have read and understood the above

Required

Statement of Commitment for Referring Partners

Young people who have been to LIFEbeat camp return with better self-esteem, more confidence and a greater ability to manage and understand their own emotions. This tends to result in more positive participation in their school or youth organisation. To support young people to get the most out of our programme, we ask the referring partner to commit to pre and post-camp communication. This is to enhance the young people’s learning and experience and to maximise the safeguarding of all participants. We try to work in collaboration regarding safeguarding with referral partners where necessary.

I will commit to one meeting in-person/online pre-camp with LIFEbeat to discuss my referral, and one meeting post-camp with LIFEbeat to discuss any safeguarding issues, learning opportunities and outcomes which have arisen at camp.

The information I have shared is accurate, to the best of my knowledge and in the young person’s best interests I have not withheld any information relating to safeguarding.

I agree to the above Statement of Commitment for Referring Partners.

Required

Are you happy to receive LIFEbeat newsletters and updates moving forwards? *

Yes

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