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Section 1 – School Details

Role:

Section 2 – Child / Young Person Details

Date of birth:
Day
Month
Year

Section 3 – Reason for Referral

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

Section 4 – Child’s Interests

What sport(s) would the child be interested in?
Football
Basketball
Boxing
Rugby
Cheerleading
Gymnastics
Swimming
Horse Riding
Martial Arts
Other
Has the child previously participated in sport or clubs?
Yes
No

Section 5 – Additional Support Needs

Does the child have any additional needs or considerations?
Yes
No

Information will only be shared on a need-to-know basis in line with safeguarding and GDPR.

Section 6 – Safeguarding Confirmation

By submitting this referral, the school 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

• Match the child with a suitable grassroots club (subject to funding and spaces)


We aim to respond within 10–14 working days.

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