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 @ £1600.00 for 2 days
Dates required? Please only tick the dates you want your child to attend *

November 2018 - One to One in Spain. (Dates to be agreed. Please email your preferred dates to us). Family Home Intervention (Dates to be agreed. Please email your preferred dates to us). Easter 2019 7th to13th April 2019 - UK Male Group Camp Easter 2019 14th to 20th April 2019 - UK Male Group Camp
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