Teencamps-UK Application and Assessment Form

Teencamps-UK Application and Assessment Form

** Please give as much detailed information as possible in your answers as this will be used to assess if your young person will be suitable to attend a camp**
Information that we require
Which camp are you applying for? *

Male UK Group camp @ £1600.00 per week One to One camp in Spain @ £3200.00 per week Family Home Intervention @ £1600 for 2 days
Dates required? Please only tick the dates you want your child to attend *

29th July to 4th August 2018 - Male UK Group Camp 12th August to 18th August 2018 - Male UK Group Camp 19th August to 25th August 2018 - Male UK Group Camp Summer 2018 - One to One in Spain (Dates to be agreed please email your request) October Half Term 21st to 27th October 2018 - One to One in Spain October Half Term 28th October to 3rd November 2018 - One to One in Spain Family Home Intervention Dates to be agreed. Please email your preferred dates to us.
Optional Services
Are any Optional Services required? *

Written Report @ £240.00 Telford, Pick up/ Drop off (UK camps only) @£160.00 None - No optional extras required
Young Persons Details
Name of Young Person *

First Name Middle Name Last Name
Age *
Date of Birth *
Gender *

Male Female
FULL details of issues and family history. Give as much information as possible *
WHAT does the family hope this camp will achieve? *
Has the young person had Counselling previously? If Yes then please give full details *
Do they have a disability? If Yes then please give full details *
Do they have any criminal convictions? If Yes then please give full details *
Do they use drugs and alcohol? If Yes then please give full details *
Are they in education? If Yes then please give full details including school address *
Are they involved with any external Services? If Yes then please give full details *
Do they have any allergies? If Yes then please give details *
Do they have any special diet requirements? If Yes then please give details *
Parents / Guardian Details
Parent / Guardian FULL NAMES? *
FULL address and postcode *
Telephone Number? *
Email Address? *
Payment Method
I wish to pay by *

BACS
Terms and Conditions
I have read, understood and agree to Teencamps-UK Terms & Conditions *

Yes
I agree that if my application is successful I will make full payment within 48 hours to secure my place *

Yes
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Teencamps-UK Application and Assessment Form

Information that we require

Optional Services

Young Persons Details

Parents / Guardian Details

Payment Method

Terms and Conditions