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 Male Group camp @ £1600.00 per week Individual Programme in UK @ £2400.00 per week Individual Programme in Spain @ £2400.00 per week Individual Online Counselling @ £50.00 per 50 min session
Dates required? Please only tick the dates you want your child to attend *

2021 Easter 4th-10th April UK Male Group Camp @ £1600.00 per week 2021 Easter 11th-17th April UK Male Group Camp @ £1600.00 per week Individual Programme, UK @ £2400.00 per week. (Dates to be agreed. Please email your preferred dates to us). Individual Programme, Spain @ £2400.00 per week. (Dates to be agreed. Please email your preferred dates to us). Individual Online Counselling @£50.00 per 50 min session (Dates to be agreed. Please email your preferred dates and times to us).
Optional Services
Are any Optional Services required? *

Telford, Pick up/ Drop off (UK camps only) @ £160.00 Written Report @ £260.00 Alicante Airport, Spain Pick up/ Drop off @ £160.00 None - No optional extras required
Young Persons Details
Full 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 or have they been hospitalised? 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 or any cases pending? 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 NAME *

First Name Last Name
FULL address and postcode *
Telephone Number? *
Email Address? *
Payment Method
I wish to pay by *

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

Yes
I agree that I will collect my young person from camp if they are dismissed or if I chose to remove them. *

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

Yes
Should be Empty:

Now create your own JotForm - It's free! Create your own JotForm

Teencamps-UK Application and Assessment Form

Information that we require

Optional Services

Young Persons Details

Parents / Guardian Details

Payment Method

Terms and Conditions