ADO River Valley Education Referral Form

 

Please Complete the Form With As Much Detail As Possible.

Fields Marked (*) Must Be Completed

If The Form Does Not Send At The End, Check All The Fields Have Been Completed. Scroll To The Top, Complete The Field With The Error and Then Try Re-Sending

This Form Has Been Tested On All Popular Computer Browsers and Devices. Please DO NOT Complete on Any Mobile Smart Devices or Phones.

THIS FORM CANNOT BE PART SAVED SO PLEASE ENSURE YOU HAVE ALL THE DETAILS TO HAND TO COMPLETE THE FORM. PLEASE ALSO MAKE SURE YOUR INTERNET CONNECTION IS STABLE BEFORE YOUR START.

 

 

Referrer Details

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Long Term Placement(1 year - Full Education duration, which could include Post-16)

Student Details:

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Our model provides a combination of Cognitive Behaviour Therapy, Relaxation Therapy, Animal Therapy and Occupational Therapy to suit the needs of each individual and support the students’ wellbeing.

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Emergency Contact Details for the Student

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(We use SMS or telephone calls to keep parent-carers up to date on their child/yp as required so please provide a phone number where permission is granted for both SMS and calls during the school day)

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Assessment

BILLING INFORMATION:

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Please Note: All billing fields require completion for system setup and assessments to be booked.

The assessment consists of the completion of this online referral form prior to us meeting the individual. This is classed as ‘Stage 1’ of our assessment process, followed by ‘Stage 2’ which is a two day practical assessment.

Practical Assessment

(Maximum two adults; recommended one professional and one parent-carer).

The supporting adult/adults will be required for the first 2 hours of the first day assessment. If the student settles within this time, the student is able to remain on site until the end of the school day. This allows staff to assess engagement and affirm we can safely meet their needs in the outdoor setting, before meeting them again for the second day.

Adult 1 (Required)

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Adult 2

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