Refer Now!

EMBRACE Children's Charity UK refer a child Background

We don’t believe any child needing specialist help should have to go on a waiting list.

We always carry out an initial assessment for counselling referrals and, where appropriate, will match those in need of help with specialist young people and family counsellors.

To make a referral, please complete our online referral form below.

Alternatively you can contact us by telephone or email. We aim to respond in most cases within 48 hours. Urgent referrals will be prioritised.

MAKING A REFERRAL

We need some basic information to get the ball rolling.

We appreciate that some information will be sensitive so we are not asking for much detail at this stage.

We can can reassure you that the details you disclose will be handled sensitively and we won’t be sharing or keeping personal information without your permission.

Our systems are encrypted to the highest standards and are regularly reviewed to ensure we provide the best possible service to keep your data safe.

*REQUIRED

WHO IS MAKING THE REFERRAL?

YOUR FULL NAME*

ORGANISATION

Roll/Job

CONTACT DETAILS

EMAIL*

MOBILE/TELEPHONE*

ADDRESS*
ADDRESS LINE 1

TOWN

CITY

POSTCODE*

CHILD VICTIM/WITNESS DETAILS

WHO IS/ARE THE YOUNG WITNESS(ES) OR VICTIM(S) OF CRIME?

NAME*

ADDRESS*
ADDRESS LINE 1

TOWN

CITY

POSTCODE*

GENDER
MF

AGE OF CHILD

ETHNIC ORIGIN

CHILD’s INVOLVEMENT*
Is the child a victim of, or witness (indirect victim) to the crime?
VictimWitness

PARENT/CARER/GUARDIAN NAME*

ADDRESS*
Same as aboveAdd address

ADDRESS LINE 1

TOWN

CITY

POSTCODE

ADD SECOND CHILD
If this referral is for more than one child, select checkbox below (maximum 4 children/young adults per referral)
Add Child

NAME

GENDER
MF

AGE OF CHILD

CHILD’s INVOLVEMENT
Is the child a victim of, or witness (indirect victim) to the crime
VictimWitness

ADD THIRD CHILD
Add Child

NAME

GENDER
MF

AGE OF CHILD

CHILD’s INVOLVEMENT
Is the child a victim of, or witness (indirect victim) to the crime
VictimWitness

ADD FOURTH CHILD
Add Child

NAME

GENDER
MF

AGE OF CHILD

CHILD’s INVOLVEMENT
Is the child a victim of, or witness (indirect victim) to the crime
VictimWitness

MAIN CARER’S MOBILE NUMBER

MAIN CARER’S EMAIL

DETAILS OF THE CRIME

Please indicate the type of crime suffered by the child or young person

WHEN DID IT OCCUR

WHICH POLICE FORCE IS INVESTIGATING (IF APPLICABLE)?

Please summarise the circumstances of the crime and, specifically, why you are making the referral.

What is/was the impact of the crime on the child or young person being referred? How has it affected their everyday life? Is the child or young person behaving differently since the crime?

SUPPORT REQUIRED?

What kind of help and support do you think would most help the victim/witness to recover and move on from what has happened?

Time4U - Please choose area for which you wish the referral to be made:

Please state gifts:

Once we’ve received your referral, you’ll receive an acknowledgement and a unique reference number which we’ll ask you to keep safe as it will identify your application.

We’ll then consider the circumstances of the case and one of our specialist team members will contact you to discuss the way forward.

MAKING A REFERRAL

*REQUIRED

WHO IS MAKING THE REFERRAL?

CONTACT DETAILS

CHILD VICTIM/WITNESS DETAILS

DETAILS OF THE CRIME

SUPPORT REQUIRED?

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