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To complete a referral to our Alternative Provision service, please complete the details as needed. The Referrer should complete this with the parent present or with verbal permissions granted for consent. To successfully submit your form, please ensure all boxes are complete.

Does the child help look after someone at home? (For example: providing regular practical help, emotional support, translation, supervision, or helping to keep a parent, sibling, or family member safe.)
Yes
No
Unknown
Safeguarding status
Proposed start date
Day
Month
Year
Proposed end date
Day
Month
Year
Choose a Learning Package - please note we may facilitate some small group sessions, alongside one to one, if we believe that these can contribute meaningfully towards positive SEMH outcomes, and/or meeting learning objectives
Do we need to attend a PEP or Annual Review meetings? *All meetings we attend will be charged at £55 per hour + VAT.
Yes
No
Unsure
What days/times are you available during school hours? (9am-4pm)
Is there parental/guardian consent for photos/videos of the child to be used for BTC internal use only?
Yes
No
Is there parental/guardian consent for photos and videos of the child to be shared on BTC social media?
Yes
No
Is there parental/guardian consent for photos/videos of the child to be used on BTC website/advertising materials?
Yes
No
Is there parental/guardian consent for transport?
Yes
No
Is there parental/guardian consent for first aid?
Yes
No
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Pricing:

£55 + VAT for 1:1 tuition

£40 per hour small group tuition


Once we receive this information, we will get back to you with proposed hours and a suitable package.

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