121 Youth Support Referral Form
You can refer yourself into the service (if you are aged 13 or above), or be referred by a parent/carer/guardian or someone who works with you (like a teacher, GP or social worker). If you are referring on behalf of a young person, please talk to the young person first about what is on offer and whether they would like some extra support.

If you have any questions about this form please contact Mel, our youth services coordinator on 07549 789295.

To see our safeguarding policy statement and procedures please click here: Proud2Be CIC Safeguarding Policy

We treat your data very carefully and respectfully, we do not share it with anyone unless legally obligated. Please complete the following questions to help us make sure we are meeting our legal obligations in regard to data protection and safeguarding.
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