Cause for Concern

Cause for Concern

Do you consider this young person to be at immediate risk of harm?

YesNo

Contact the Youth Zone directly

or in an emergency contact the Police on 999

Please describe in one line what you are concerned about

Young person

First name

Last name

Date of birth

Details

Date of incident

Time of incident

Youth Zone session

Description of concern

For example:

Any physical, behavioural or other indicators e.g. bruises, behaviour changes, periods of absence
Any information relating to the young person's home life e.g. substance abuse, domestic violence, mental health issues

Anyone else involved

Please provide the names of anyone else involved and their role in the incident/concern e.g. staff, volunteer, young person, sibling.

Other information

Please describe any actions already taken

e.g. spoken to Youth Zone staff, informed parents, school, police or other agencies

Additional information

e.g. preferred name of the young person, people who should not be contacted, next steps (if known)

Submitted by

Name

Role

Email

Phone number

Privacy Notice

Your personal information will be used to respond to your enquiry and administer the service.

Where there is a need to protect or support a young person, we may also share personal information with relevant agencies as required by law.

For further information about how we process your personal information, who we may share it with, and your rights, please read our Privacy Policy.

Your personal information will be used to respond to your enquiry and administer the service.

Where there is a need to protect or support a young person, we may also share personal information with relevant agencies as required by law.

For further information about how we process your personal information, who we may share it with, and your rights, please read our Privacy Policy.

Your personal information will be used to respond to your enquiry and administer the service.

Where there is a need to protect or support a young person, we may also share personal information with relevant agencies as required by law.

For further information about how we process your personal information, who we may share it with, and your rights, please read our Privacy Policy.

Your personal information will be used to respond to your enquiry and administer the service.

Where there is a need to protect or support a young person, we may also share personal information with relevant agencies as required by law.

For further information about how we process your personal information, who we may share it with, and your rights, please read our Privacy Policy.

Your personal information will be used to respond to your enquiry and administer the service.

Where there is a need to protect or support a young person, we may also share personal information with relevant agencies as required by law.

For further information about how we process your personal information, who we may share it with, and your rights, please read our Privacy Policy.

Your personal information will be used to respond to your enquiry and administer the service.

Where there is a need to protect or support a young person, we may also share personal information with relevant agencies as required by law.

For further information about how we process your personal information, who we may share it with, and your rights, please read our Privacy Policy.

Your personal information will be used to respond to your enquiry and administer the service.

Where there is a need to protect or support a young person, we may also share personal information with relevant agencies as required by law.

For further information about how we process your personal information, who we may share it with, and your rights, please read our Privacy Policy.

Your personal information will be used to respond to your enquiry and administer the service.

Where there is a need to protect or support a young person, we may also share personal information with relevant agencies as required by law.

For further information about how we process your personal information, who we may share it with, and your rights, please read our Privacy Policy.

Your personal information will be used to respond to your enquiry and administer the service.

Where there is a need to protect or support a young person, we may also share personal information with relevant agencies as required by law.

For further information about how we process your personal information, who we may share it with, and your rights, please read our Privacy Policy.

Your personal information will be used to respond to your enquiry and administer the service.

Where there is a need to protect or support a young person, we may also share personal information with relevant agencies as required by law.

For further information about how we process your personal information, who we may share it with, and your rights, please read our Privacy Policy.

Your personal information will be used to respond to your enquiry and administer the service.

Where there is a need to protect or support a young person, we may also share personal information with relevant agencies as required by law.

For further information about how we process your personal information, who we may share it with, and your rights, please read our Privacy Policy.

Your personal information will be used to respond to your enquiry and administer the service.

Where there is a need to protect or support a young person, we may also share personal information with relevant agencies as required by law.

For further information about how we process your personal information, who we may share it with, and your rights, please read our Privacy Policy.

Your personal information will be used to respond to your enquiry and administer the service.

Where there is a need to protect or support a young person, we may also share personal information with relevant agencies as required by law.

For further information about how we process your personal information, who we may share it with, and your rights, please read our Privacy Policy.

Your personal information will be used to respond to your enquiry and administer the service.

Where there is a need to protect or support a young person, we may also share personal information with relevant agencies as required by law.

For further information about how we process your personal information, who we may share it with, and your rights, please read our Privacy Policy.

Your personal information will be used to respond to your enquiry and administer the service.

Where there is a need to protect or support a young person, we may also share personal information with relevant agencies as required by law.

For further information about how we process your personal information, who we may share it with, and your rights, please read our Privacy Policy.

Your personal information will be used to respond to your enquiry and administer the service.

Where there is a need to protect or support a young person, we may also share personal information with relevant agencies as required by law.

For further information about how we process your personal information, who we may share it with, and your rights, please read our Privacy Policy.

Your personal information will be used to respond to your enquiry and administer the service.

Where there is a need to protect or support a young person, we may also share personal information with relevant agencies as required by law.

For further information about how we process your personal information, who we may share it with, and your rights, please read our Privacy Policy.

Your personal information will be used to respond to your enquiry and administer the service.

Where there is a need to protect or support a young person, we may also share personal information with relevant agencies as required by law.

For further information about how we process your personal information, who we may share it with, and your rights, please read our Privacy Policy.

Source Information

Youth Zone

Created via web form?

TRUE

Contact Information
Your Rights Under GDPR