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TEENAGE Registration Form (13-19yrs) Manhood Academy Global
Thank you for contacting us. For us to do what we do we need to ask a few questions. You are required to complete this online form. Thank you
* Indicates required question
Name of the person completing this form
*
(Your full name please)
Your answer
What is your relationship with the young person
*
Your answer
What is your contact email address?
*
Your answer
What is your contact number?
*
Mobile or landline
Your answer
The name of the young person
*
Your answer
Is the young person aware of our programme?
*
Yes
No
Young person's full address and postcode
*
Your answer
Young person's Age
*
Your answer
Young person's contact details
*
Mobile number
Your answer
Are their any other professional's involved?
*
Social Services, Youth Offending Services etc.
Your answer
What is your assessment of the risks involved in working with this young person?
*
Your answer
Why do you want this young master to join us?
*
What are your concerns?
Your answer
Main Areas of Support
*
Emotional Wellbeing
Negative Peer Group
Home Life
Personal Hygiene
Parental Respect
Educational Attainment
Crime & Disorder
Mental Health and Lack of Expression
Other:
Required
Name of School
*
Your answer
Are their any orders, sanctions or anything else that would prevent us working with this young person?
*
Your answer
The investment attached to this 'passage' is £ per month. (£15 a week cycle is £90 Will you make payment
*
Cash
Direct Debt
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