Fight Like a Girl - Referral Form
This short form takes approximately 2–3 minutes to complete and allows you to express interest in a place on the programme. Completing this form does not register a participant or guarantee a space. Once we have reviewed the referral, a member of the Fight Like a Girl team will be in touch. If a place is available, we will also contact the parent or carer to complete a simple consent form and confirm participation.
Your name
*
Organisation (if applicable)
Your relationship to the girl
*
Parent/Carer
Social Worker
Teacher/School
Youth Worker
Support Worker
Other
Your email address
*
Your phone number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Girl's first name
*
Girl's last name
*
Girl's date of birth
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Please select a year
0
01
011
0111
01111
Year
Her school or setting
The school, PRU, alternative provision or service she is currently with
Which programme or area is this referral for?
Please Select
DEFEND (council or statutory service programme)
EMPOWER (school or alternative provision programme)
Not sure, we'll talk it through
Why would you like to refer this girl to Fight Like a Girl?
*
What would you like her to gain from the programme?
*
I confirm Fight Like a Girl can contact the parent/carer regarding this referral.
*
Submit Referral
Should be Empty: