01706 860247


If roughsleeper or homeless, please provide hostel details or other contact point
If available
Office telephone number
Mobile number
Only if necessary (eg. GP, Social Worker, Probabtion Officer)
Please add the relevant details for your referral
Please select all that apply
Please add the relevant details for the client's problems
Under the EU General Data Protection Regulation (GDPR), the information provided by you in this registration form will be held by High Level (Northern) Trust as data controller. The information will be used by High Level (Northern) Trust as permitted by you in the above application. Your contact details (name, contact address, telephone number, e-mail, and social media) and information will not be shared, unless you have given us permission to share it or we believe you are going to harm yourself or others. Please note we are bound by child protection laws and if we believe a child is coming to any kind of harm or suffering from neglect we are required to report this information.
No other information will be passed on to a third party without written or verbal permission.
NB. We have further policies available if you require them. They include child protection, safeguarding, full GDPR policy, health and safety etc etc.