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 type of camp/ service are you applying for? Please only tick the camp you want your child to attend *

UK Group camp @ £1600.00 per week Individual Programme in UK @ £3200.00 per week Family Online Intervention @ £110.00 per 50 min session. Individual Online Counselling @ £50.00 per 50 min session
Dates required? Please only tick the dates you want your child to attend *

Summer 2020 -26th July - 1st August 2020 - Female only Group Camp Summer 2020 -2nd - 8th August 2020 - UK Male Only Group Camp Summer 2020 -9th - 15th August 2020 - UK Male Only Group Camp Summer 2020 -16th - 22nd August 2020 - UK Male Only Group Camp Summer 2020 -23rd - 29th August 2020 - UK Male Only Group Camp Individual Programme, UK @ £3200.00 per week. (Dates to be agreed. Please email your preferred dates to us). Family Online Intervention @ £110.00 per 50 min session (Dates/ times to be agreed. Please email your preferred dates/ times to us). Individual Online Counselling @ £50.00 per 50 min session (Dates/ times to be agreed. Please email your preferred dates/ times to us).
Optional Services
Are any Optional Services required? *

Written Report @ £260.00 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? *
How would you describe your parenting style? *
Are you open to changing your parenting style if necessary? *
Has the young person had Counselling previously? If Yes then please give full details *
Do they have any mental health issues? If yes then please provide details *
Have they ever self harmed? If Yes then please give details *
Do they use drugs or alcohol? 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 *
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 PayPal
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 24 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