Out of the Blue attendance enquiry

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Please select your role
Attendee details
How did you hear about us?
By telling us how you heard about hoot and our sessions you will be helping us to evaluate our publicity and marketing and make changes to improve visibility and accessibility.
Do you/they have a Keyworker, CPN or Social Worker?
Keyworker/CPN Details
If there is a Keyworker, have they carried out a risk assessment?
Emergency Contact Details
hoot may contact your client's emergency contact if we have concerns regarding their health whilst attending the service. Please ask your client to inform their emergency contact that their details have been given to HOOT for this purpose.
Doctor's Details
Attendance
Attended hoot before?
Interested in
Interested in
Part 1: Which of the following applies to you/the person you are referring?
Part 2: Which of the following applies to you/the person you are referring? Select all that apply
Have you/they got a Community Care Assessment (CPA)?
Are you/is this person eligible for Direct Payments / Personal Budget?
Have you/they accessed any other services in Kirklees?
Referrer Details
Referrer Organisation Details
Risk Factors
I confirm that the person I am referring is able to participate in Out of the Blue activities independently, or will be provided with the appropriate support. (Contact hoot if in doubt)

Dignity & Respect
hoot believes everyone participating in our activities should be treated with dignity and respect. Verbal abuse, bullying and aggression towards staff, volunteers or other participants is unacceptable, and constitutes grounds for exclusion from all activities.

The data submitted on this form will be stored securely in hoot Creative Arts' database in order to process your referral and contact you with regards to attending sessions. You can read our Privacy Policy here.