Teencamps-UK Application and Assessment Form
Information that we require
** Important - 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 **
Information and Optional Services
Which type of camp/ service are you applying for? Please only tick the actual services you require
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Male One to One Residential in SPAIN or the UK - 7 day minimum
Consultation
Dates required?
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Male One to One Residential in SPAIN or UK @ £6200.00. Minimum 7 day stay but no limit on the length of stay. Please advise in the "FULL Details" section which dates you require from 15th October 2025 onwards and in which country.
Consultation @ £120.00 per 30 min session. Please advise suitable times and dates you require.
Optional Extras
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None
Depression Assessment @ £160.00
Anxiety Assessment @ £160.00
Dyslexia Assessment @ 380.00
Autism Assessment @ £380.00
Written Report @ £360.00
ADHD Assessment @ £480.00
Young Persons Details
Full Name of Young Person
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First Name
Middle Name
Last Name
Gender
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Male
Female
Age
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Date of Birth
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FULL details of issues and family history. Give as much information as possible.
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WHAT does the family hope this intervention will achieve?
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How would you describe your parenting style?
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Are you open to changing your parenting style if necessary?
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Has the young person had Counselling previously? If Yes then please give FULL details of the type of Counselling received, how long, who with etc.
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Are they on any medication? If Yes then please provide details including prescription details, amount to be taken, how often, side effects experienced, etc.
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Do they have any current or previous mental health issues or have they ever been hospitalised? If Yes then please provide FULL details including dates, how long for, location etc
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Have they ever self harmed? If Yes then please give FULL details.
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Do they use drugs or alcohol? If Yes then please give FULL details of what they take, how much, how often etc.
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Do they have any previous criminal convictions or have they been involved in any recent criminal activity and have any court cases pending? If Yes then please give FULL details
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Do they have a disability? If Yes then please give FULL details
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Are they in education? If Yes then please give FULL details including school address. If not, then please advise what current education they are receiving
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Are they involved with any external Services (including Social Services)? If Yes then please give FULL details
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Do they have any allergies and are these life threatening? If Yes then please give details
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Do they have any special dietary requirements? If Yes then please give details
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Does the young person speak fluent English?
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Yes
No
Where did you hear about Teencamps-UK?
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Parents / Guardian Details
Parent / Guardian FULL NAME
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First Name
Middle Name
Last Name
FULL address and postcode
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Telephone Number
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Email Address
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Payment Method
I agree to pay in GBP (£) by
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BACS
Terms and Conditions
I have read, understood & agree to Teencamps-UK Terms & Conditions.
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Yes
I agree that I will collect my young person from the residential if they are dismissed for any reason or if I chose to remove them. See T&C's on the website at www.teencamps-uk.com
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Yes
Submit
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