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Game On - Palace for Life

Fill out the form below to make a referral.

Game On – Palace for Life – 2024/25

Referral form for employability support through the Game On programme.

Who is making the referral?:

What upcoming activities are you interested in?

Referrer’s first name:

Referrer’s surname:

Referrer’s organisation:

Referrer’s email address:

Referrer’s contact number:

Young Person’s details

This section will help us gather all the information we need to support the Young Person.

If you are a referring yourself please note that from this point on any question that asks about ‘Young Person’ is about yourself.

Young Person’s first name:

Young Person’s surname:

Young Person’s Email Address:

Young Person’s phone number:
If the young person is happy to be contacted by us directly about the referral, please include their number here.

Young Person’s post code:

Borough:

Young Person’s gender:

Young Person’s date of birth (DD/MM/YYYY):

Young Person’s ethnicity:

Young Person’s nationality:

Education, Training or Employment Status:

Young Person’s employment establishment:

Young Person’s Education Placement:

Young Person’s Risk Factors:

Please explain any risks / support that we should be aware of?

Required for self-referral

First name:

Surname:

Contact number:
Please include the details of the responsible adult we can contact about the referral.

Email address:

Relationship to Young Person:

Has the Young Person been on any Palace for Life programme previously?

How did you hear about the Game On programme?

Anything else?:

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