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Referral form

Use the form below if you are referring someone onto one of our small group sessions for The Bay.

Please use this form to refer someone else onto The Bay programme. If you have any questions, please don't hesitate to get in touch with a member of our team.

To find out more about the different sessions we offer, scroll to the 'Session types' section on the website.

T: 01772 872007 or 07738 102274 (mobile)
E: info@thebay.org.uk

If you're looking to self-refer, head to our self-referral form:

Self-referral form

Details of person being referred
Please only put an email address in this box. If you put any other text, please be aware that you may get an error message on submitting, however we will have received your form so don't worry.
Details of referrer
Has the individual consented to this referral?
Is being with a group of six people okay?
Known safeguarding issues
Risk to self
Self neglect
Self harm
Suicide attempt
Drug/alcohol misuse
Isolation
Risk/abuse from others
Physical
Financial
Sexual
Other
Risk to others
Is there potential for violent or aggressive behaviour?
Are there any concerns regarding safety to work alone?
Are there any concerns regarding safety to work alone in a group?
Risk to property
Theft
Damage
Other
Equal opportunities
In accordance with Lancashire Wildlife Trust’s policy on equal opportunities, we will provide equal opportunities to any participant and will not discriminate either directly or indirectly on the grounds of race, colour, ethnic origin, nationality, national origin, sex, sexual orientation, religion or belief, marital status, civil partnership, age, gender reassignment or disability.

We would therefore be grateful if you could complete the questions on this form. All information will be treated in confidence and is collected for project monitoring purposes only.
Gender
What gender do you identify with?
Ethnicity
Disability and impairment
Do you identify yourself as a deaf or disabled person?
Sexuality
Which pronouns do you prefer to be referred to as?

This helps us to know the best way to address you.

For example: Your pronouns would be she/her if you'd like us to say 'yes, it's her bag, she left it here' in the event of you leaving your bag behind one day.
Referral next steps - who should we contact?
Are they under 18?
Please tick one

Read our privacy statement for more information on how we use your data:

Privacy statement