Refer a parent or family

Introduce a Family to The Chance Hub.

Please complete this form with the parent or carer's consent. We only ask for the information we need to make contact and understand what support the family is looking for. We will contact the parent/carer directly within five working days. Fields marked * are required.

🔒 Your information and privacy

The Chance Hub takes the privacy of families seriously. Information provided on this form will be used to consider the referral, contact the family and provide appropriate support. Information will be kept securely and will not be shared with other organisations without consent, unless there is a safeguarding concern or we are required to do so by law.

The Chance Hub Privacy Notice

Important: We are not a replacement for statutory, clinical or specialist services. Please ensure the family is aware of and has consented to this referral before submitting.

Your details

Your full name*

Your role / job title*

Organisation / school / service*

Your email address*

Your phone number

Family details

Parent / carer first name*

Parent / carer last name*

Child / young person's first name*

First name only is fine

Child / young person's age*

Family phone number*

Family email address

Optional

Referral details

Reason for referral*

Please describe why you are referring this family and what support you feel they may benefit from.

Current support in place

Optional — please list any services or support the family is already receiving.

Any other information

Optional — anything else you feel would be helpful for us to know.

Consent confirmation

I confirm that the parent or carer named above is aware of and has consented to this referral being made to The Chance Hub. I understand that The Chance Hub will contact the family directly using the details provided.

Cancel