Limitless Fitness Centre Referral Form
We specifically support young people identified as facing more than one risk factor from those detailed below

  • Displaying signs of anti–social behavior
  • Either disengaged, excluded or at risk of exclusion from education
  • Or not in employment or training (NEET)
  • In or leaving care
  • Experiencing significant challenges out of school – including factors such as a lack of role models, family breakdown, bereavement, isolation and historic domestic violence.
Which programme do you require? *
Please explain the reason for the referral?*
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Are you a Parent/Guardian/Carer or Professional
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Full Name *
Email address *
Contact number  *
Your role  *
Child's Name *
Date of birth  *
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Gender *
Address *
Ethnicity  *
Religion  *
Does the young person being referred have any health care or social care needs? If Yes, please explain
 *
Does the young person have a social worker?
 *
How will the young person be funded for this programme?
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How did you hear about us
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 The information you provide on this form is subject to the provisions of the Data Protection Act 1998.The collection and use of personal data by Limitless Fitness Centre complies with the UK data protection laws and the GDPR.
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