FMG Project Foundation Programme Referral Form

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This is a referral form for FMG Project's FREE 10-week group-based Foundation Programme. The young person that you are referring to us must ideally be:
- Aged 14-16 (school years 10 and 11)
- Experiencing one or more barriers to participation in sport or exercise
- Motivated to grow, learn and change.
If not all apply, feel free to do the referral anyway and we can discuss how we can best support your young person.

The Academy Programme sessions will run twice a week on Monday and Wednesday evenings from 4-5pm.

The sessions will include:
- Strength and conditioning training
- Motivational mindset coaching
- 1-1 mentoring and support
- Making friends with others

Unfortunately, we cannot guarantee that the young person that you are referring will be taken onto the programme. We reserve the right to select the young people that we feel are an appropriate fit. If you have any concerns or questions about anything to do with the programme, please get in touch.

Sam Crocker-Green, FMG Project Manager and Coach
Email: sam@fmgproject.co.uk
Phone: 01273 837750

The information on this form will be recorded on a database along with any details relevant to subsequent FMG Project involvement. These records will be held and used in accordance with the provisions of the Data Protection Act 2008.

Do you and the young person you are referring, understand the above and what the programme will involve?

Yes

Clear selection

Young Person's Name:

Date of Birth:

YYYY

School Year:

Clear selection

School:

Parent/Carer Name:

Parent/Carer Email:

Parent/Carer Mobile Number:

Referrer Name:

Referrer Organisation:

Referrer Email:

Are there any other agencies working with the young person? If yes, please list them below.

How many of the following apply to the young person? Please tick all that apply:

Free school meals

Parents/guardians claim benefits

Council/supported housing

Criminal Record

Live/lived in care

Have caring responsibilities

Diagnosed mental health condition

Learning difficulties

Disability

Persistent non-attendance/engagement in academia

Is the young person part of a sports club? If yes, please state the sport and what level they are currently playing at eg. school, club, regional, national

What does the young person want to get out of the programme, if selected?

Finally, please provide any other information that might be helpful for us to know:

Submit

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