Referral Form

This information is very important to us.

The information will help us to understand how best we can support each child. Solidarity Sports will keep the information confidential and we will not give it to other services, unless it is to protect the child or to meet other legal responsibilities. Please note:

• The form must not be completed by the parent
• Please complete all sections (including info shared on telephone)
• If you don’t know, please say so or type N/A if not applicable
• If you are referring children from different families, please complete two seperate forms
• Any questions, call 020 7376 0032

Child's first name *This question is required.

Child's last name *This question is required.

Child's date of birth *This question is required. This question requires a valid date format of DD/MM/YYYY.

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Child's gender *This question is required.

Child's age *This question is required.

Name of Centre/School *This question is required.

Centre/School tel. number *This question is required.

Name of person referring
*This question is required.

Email of person referring *This question is required.

Tel. number of person referring *This question is required.

Mobile tel. number of person referring *This question is required.

Reason for referral (we'll ask about details later) *This question is required.