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Section 1 – Referring Organisation

Section 2 – Child / Young Person Details

Section 3 – Reason for Referral

Please indicate the reason(s) for referral (tick all that apply):

Please do not include confidential case notes.

Section 4 – Child’s Interests

What sport(s) would the child be interested in?
Has the child previously participated in sport or community clubs?
Yes
No

Section 5 – Additional Needs

Are there any additional needs or considerations we should be aware of?
Yes
No

Information shared will be limited and handled in line with safeguarding and GDPR.

Section 6 – Safeguarding & Information Sharing

By submitting this referral, the referring service confirms:

Section 7 – Declaration

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Date
Day
Month
Year

What Happens Next


Village United CIC will:

• Review the referral

• Contact the parent/carer directly

• Assess eligibility and availability

• Liaise with partner clubs where appropriate

• Confirm outcome with the referring service (where consent allows)


Response timeframe: 10–14 working days

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