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?
One to One camp in Spain @ £3200.00 per week
Male UK Group camp @ £1600.00 per week
Family Home Intervention @ £1600 for 2 days
Dates required? Please only tick the dates you want your child to attend
May Half Term 27th May to 2nd June 2018 - One to One in Spain
Summer 2018 29th July to 4th August 2018 - Male UK Group Camp
Summer 2018 5th August to 11th August 2018 - Make UK Group Camp
Summer 2018 12th August to 18th August 2018 - Male UK Group Camp
Summer 2018 19th August to 25th August 2018 - Male UK Group Camp
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.
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
Date of Birth
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
I wish to pay by
PayPal (please note that there will be an additional 3.6% surcharge for using this method)
Terms and Conditions
I have read, understood and agree to Teencamps-UK Terms & Conditions
I agree that if my application is successful I will make full payment within 48 hours to secure my place
Should be Empty:
Now create your own JotForm - It's free!
Create your own JotForm