Cherished & ROAR Courses Referral Form - School & Agencies

At Cherished we are passionate about supporting children to feel safe, seen, soothed and secure through kindness, compassion and connection. As a team we are dedicated to offering a high quality service. Please complete in as much detail as possible so we can ensure the correct support will be assigned to the young person you are referring.
Thank you.

Cherished Team

Email *

First Name *

Last Name *

Job Title/Occupation *

Organisation name *

Town/City *

Referral Contact Number (Day) *

For your information, the cost of the Cherished & ROAR courses are £180 per child, please refer to the courses section of this form to understand the duration of each course.

How is this support being funded?

Primary school

Secondary School

Other

Parent/Carer Details

Parent/carer email

Parent first name

Parent last name

Parent contact number

Needs Assessment

Does the child access any other services that Cherished offers? *

Is this young person receiving any other intervention? *

What do you feel this young person needs and why? *

Have you spoken with the young person about what they feel they need? If, please advise what they have communicated they need. *

Please share with us any helpful information that we should be aware of in order for us to be able to support the young person in a trauma informed way.

Which Cherished service will best support the referral needs? (Up to 8 girls per course, to be referred by school only) *

Cherished 8 Week Primary Course (You can refer up to 8 girls)

Cherished 9 Week secondary Course (You can refer up to 8 girls)

Kindness Counts Secondary (6 week course - you can refer up to 8 girls in years 7 & 8)

Little Sprouts Primary (8 week course for up to 10 children mixed boys & girls in years 4, 5, & 6)

Which Roar service will best support the referral needs? (Up to 8 boys per course, to be referred by school only) *

Roar I Am Able (primary 8 week course for up to 8 boys per group)

Little Sprouts (8 week course for up to 10 children mixed boys & girls in years 4, 5, & 6)

Needs Assessment Con't

Can you identify the triggers for the behaviours of the young person you are referring and state them below? *

Attendance Please complete as a percentage *

Unauthorised absences

Main reasons for absences

Please can you indicate where you feel this child is in terms of mental health & wellbeing and how that translates into a percentage (for our reporting & evaluation purposes) *

Are they currently at risk of exclusion?

Yes

Unsure