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
*
Male Behavioural Camp in Spain or the UK - 7 day minimum
Male One to One Residential in SPAIN or the UK - 5 day minimum
Male Group UK Residential - 7 day minimum
Family Home Visit
Consultation
Online Family Mediation
Dates required?
*
Male One to One Behavioural Camp in Spain or the UK @ £4800.00 per week.
Male One to One Residential in SPAIN or UK. Minimum 5 day stay but no limit on the length of stay. Please advise in the "FULL Details" section which dates you require from 15th Sept 2025 onwards and in which country.
5 days @ £4800.00
7 days @ £6200.00
10 days @ £8800.00
14 days @ £10600.00
Male UK Group Residential October Half Term 2026 @ £4600.00 per week.
Male UK Group Residential Easter 5th - 11th April 2026 @ £4600.00 per week.
Family Home Visit @ £3,200.00 for 3 days (dates to be agreed) plus additional expenses to and from your home (flights, accommodation, transport etc).
Consultation @ £250.00 per 30 min session. Please advise suitable times and dates you require.
Online Family Mediation- Price from £160.00 per 55 minute session.
Optional Extras
*
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
*
First Name
Middle Name
Last Name
Gender
*
Male
Female
Age
*
Date of Birth
*
FULL details of issues and family history. Give as much information as possible.
*
WHAT does the family hope this intervention 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 of the type of Counselling received, how long, who with etc.
*
Are they on any medication? If Yes then please provide details including prescription details, amount to be taken, how often, side effects experienced, etc.
*
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
*
Have they ever self harmed? If Yes then please give FULL details.
*
Do they use drugs or alcohol? If Yes then please give FULL details of what they take, how much, how often etc.
*
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
*
Do they have a disability? If Yes then please give FULL details
*
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
*
Are they involved with any external Services (including Social Services)? If Yes then please give FULL details
*
Do they have any allergies and are these life threatening? If Yes then please give details
*
Do they have any special dietary requirements? If Yes then please give details
*
Does the young person speak fluent English?
*
Yes
No
Where did you hear about Teencamps-UK?
*
Parents / Guardian Details
Parent / Guardian FULL NAME
*
First Name
Middle Name
Last Name
FULL address and postcode
*
Telephone Number
*
Email Address
*
Payment Method
I agree to pay in GBP (£) by
*
BACS
Terms and Conditions
I have read, understood & agree to Teencamps-UK Terms & Conditions.
*
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
*
Yes
Submit
Should be Empty: