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
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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
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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?
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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
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First Name
Middle Name
Last Name
Age
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Date of Birth
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Gender
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Male
Female
FULL details of issues and family history. Give as much information as possible
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WHAT does the family hope this camp 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
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Do they have any mental health issues or have they been hospitalised? If yes then please provide details
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Have they ever self harmed? If Yes then please give details
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Do they use drugs or alcohol? 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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Do they have any criminal convictions or any cases pending? 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
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Are they involved with any external Services? If Yes then please give full details
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Do they have any allergies? If Yes then please give details
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Do they have any special diet requirements? If Yes then please give details
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Parents / Guardian Details
Parent / Guardian FULL NAME
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First 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 wish to pay by
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BACS
PayPal
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 camp if they are dismissed or if I chose to remove them.
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Yes
I agree that if my application is successful I will make full payment within 48 hours to secure my place.
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Yes
Submit
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