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Is there any significant information that T.I.M.E facilitators should know and understand about you as this can help you be supported in the group: *
Medical information:
Allergies/ intolerances:
What do you wish to gain from your experience in the T.I.M.E community? *
How Did You Hear About TIME?*

PosterInstagramFacebookTikTokWord Of Mouth

Emergency contact details
Name*

First NameLast Name
Phone Number *
How will you be getting home from the weekly meetings?*

WalkingPublic transportBeing collected by a responsible adultOther
Privacy and confidentiality agreement: All information provided to T.I.M.E facilitators via this referral form will not be shared out with the group unless there is a situation of staff cover due to sickness and only the relevant information will be shared to ensure the relevant support and nurture can remain consistent for the young people in our group. Furthermore, facilitators may need to contact the referrer who has completed this form to gain further information which will enable support to the young person. *
Social media agreement: It is important for T.I.M.E to be shown on social media and to spread the fun and creativity of our young people. Do you mind being part of the social media content that is managed by T.I.M.E staff?*
If you require any further information or have any questions or queries please do not hesitate to give us a message on the following email:

thisismeempowered1@gmail.com

A group facilitator will reply to your email as soon as possible. Thank you.
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