Young person referral form

The purpose of this form is to refer either yourself, or a young person known to you for the Ruby Boots project, by Forces Children Scotland. Please contact our coordinator if you have any questions or concerns: rubyboots@forceschildrenscotland.org.uk

Full name *

First NameLast Name

Which school does the young person currently attend? *

Date of Birth *

DD/MM/YYYY

Young person's phone number *

+44Phone Number

Type of referral*

I am referring myselfReferring a young person known to me

Does the young person know about this referral?

YesNo

Your relationship to the young person *

Parent / carerOther

Referrer full name *

First NameLast Name

Referrer email address *

example@example.com

Referrer phone number *

+44Phone Number

Organisation/school

Which best applies to the young person's family status?*

Will soon be leaving military serviceAlready left: VeteranUnsure

Full name of parent/guardian*

First NameLast Name

Email address for parent/guardian

example@example.com

Phone Number for parent/guardian*

+44Phone Number

Does the young person have any additional support needs we would need to be aware of prior to beginning the group support? We want our support to be as inclusive as possible.

YesNo

If yes, please provide further information.

Does the young person have any caring responsibilities? *

YesNo

We collect and process personal data relevant to your application which allows us to assess your circumstances and eligibility. Where we do so, we act as a Data Controller and comply with all Data Protection Regulations which includes but is not limited to the UK General Data Protection Regulations (UK GDPR). We collect your consent on this form for the use of your data for specific purposes. Where you provide personal details of any other individual, or complete this application on behalf of another person please ensure that you have their consent prior to including their personal data on this application. By providing us with this information you consent to us processing the data for this purpose. For full details on how we store your personal data please see our full privacy notice here: www.forceschildrenscotland.org.uk/privacynotice. A Hard copy of this notice is also available on request.

I have read and understood the Data Protection Short Notice *

YesNo

Ruby Boots Referral Form

Young Person's details

Referrer details

Family details

Data Protection Short Notice