How To Refer A Child – Honeypot House If you are a human and are seeing this field, please leave it blank. Referrals can be made directly to Honeypot using the below online form, however should you prefer please download our referral form and email it to us at email@example.com. YOUNG PERSON New Referral to Honeypot or Repeat: (please state) Name Address Telephone Number Age Date of Birth Heritage Gender Name of parent/Guardian Total no. of Children in the Family & Ages Does the child live at home (with both parents? do they have contact with both parents? - please give as much information as possible) If the child is in care - please give full information as to reasons why, and length of time they have been in care - do they have contact with either or both parents RECOMMENDING AGENCY Name of Organisation Contact Person Position Address Email Address Telephone Number In case of Emergency please state the Out of Hours Number ABOUT THE CHILD Name & Address of the School the child attends Has the child ever had a CAF assessment completed? Special Educational Needs (please specify) Behavioral Difficulties (please give details) How long and in what capacity have you known this young person? - please give full details (i.e. if the child is on the child protection register - list the reasons why, the length of time they have been on the register etc, if the child’s parent/s are ill/disabled or have an addiction - list the illness/disability - does the child know? - Please give as much information as you can:- Why have you recommended this young person to Honeypot? How do they fit Honeypot's eligibility criteria? Will this be the child’s first holiday away from parents/guardian? Have any members of this family been on a Honeypot outing or holiday previously - if so, please give details (name of child, date of the holiday/outing) Please advise us as to the child’s regular routine regarding bathing, bedtime etc. Please outline any further details about this young person that you feel we should be aware of - i.e. their skills, needs, diet, particular anxieties, destructive behavior, a threat to others, etc. Please give as much background information on the child as possible - in particular please specify the nature of disadvantage, temperament of the child and any special interests. It is essential for the success of the holiday that we have as much information as possible.