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Our World
About Us
Come and See Us
Service Information
Supporting Students
Our Team
Join Our Team
Make a Donation
Find Us
FAQ’s
Our Programme
Programme Design
Arts & Crafts
Construction & Sculpture
Life Skills
Health & Wellbeing
Keeping Active
Out & About
Themes & Parties
Creative Arts
News & Events
Gallery
Contact
student referral form
Student Taster Day/ Referral
1
Personal Details
2
About Me
3
Things I would like to be able to do
4
Declaration
Are you looking to arrange a taster day?
(Required)
Yes
No
Untitled
Availability
From
Until
Actions
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Delete
There are no
Entries.
Add Entry
Maximum number of entries reached.
Name
(Required)
Dr.
Miss
Mr.
Mrs.
Ms.
Prof.
Rev.
Title
First
Last
Address
(Required)
Street Address
Address Line 2
Town / City
Post code
Phone number
(Required)
Email address
(Required)
Enter Email
Confirm Email
I prefer to be contacted by…
telephone
text message
email
Date of birth
(Required)
DD slash MM slash YYYY
I currently live with
Parent
Guardian
Other
Next of kin's name
First
Last
Next of kin's phone number
Key worker or social worker's name
First
Last
Key worker or social worker's phone number
Key worker or social worker's email address
Enter Email
Confirm Email
Hobbies, things I like
a
Painting
Making things
Fabrics
a
Photography
Films
Socialising
a
Music
Dancing
Singing
a
Being surrounded by people
Being somewhere quiet
My own space
a
Puzzles
Maths
Computers
a
Sport
Outdoors
Drama
Other, Please specify
Things I dislike
a
Puzzles
Maths
Computers
a
Painting
Making things
Fabrics
a
Music
Dancing
Singing
a
Being surrounded by people
Being somewhere quiet
My own space
a
Sport
Outdoors
Drama
a
Photography
Films
Socialising
Other, Please specify
Education & Training
Type of training provider
Name of training provider
Name of course/ subject/ workshop
Start date
End date
Qualification achieved
Brief description of the outcome
Actions
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Entries.
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Maximum number of entries reached.
Skills I have learned
Skills
I can read
I can write
I can communicate verbally
I can sign
Other, please specify
What is important to you that you would like from Spectrum Active?
Arts and Crafts
Very Important
Important
Not important
Socialising
Very Important
Important
Not important
Life skills
Very Important
Important
Not important
Leisure
Very Important
Important
Not important
Any further comments
When would you prefer to attend?
Availability
From
Until
Actions
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Delete
There are no
Entries.
Add Entry
Maximum number of entries reached.
Declaration
(Required)
I confirm I have filled this form correctly to the best of my knowledge, and I agree to the privacy policy.
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