Cherished & ROAR 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

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.

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