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Cherished & ROAR Referral Form

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 your child.
Thank you.


Cherished Team

Parent/Carer Details

For your information prior to requesting mentoring, please note the 1:1 Mentoring service costs of £35 per hour per week in school OR £40 per hour per week at the Cherished Connection Hub (minimum of 12 weeks).

Please indicate the duration of the mentoring required based on the current mental health and wellbeing, of the young person you are referring. Please note the support will be reviewed every 12 weeks. You will be invoiced every 12 weeks if support is required further than the minimum of 12 weeks.

Your child's address

Child/Young Person's Details

Needs Assessment

Please tick all the areas below that apply to the young person's needs

Needs Assessment Con't

Further Information

Here at Cherished we regularly deliver relevant training and parent workshops in order to best support you the parent/carer to support your child. Please indicate below whether or not you would be interested receiving emails about these services.

I agree that I have the authority to make the above referral and that the above information is correct to the best of my knowledge.

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