The Cart Shed: Agency Referral Form


Name and Date of Birth






Address




Email and Phone




Preferred Method of Contact


GP Details



Transport Details


Emergency Contact Details






IT Support
All of our courses require participants to complete paperwork for our funders. To reduce the amount of paperwork participants may be asked to complete whilst in the woods they may be asked to fill this paperwork in digitally prior to the course starting. Additionally, during lockdown our services moved online whilst we were unable to run our courses in our woodland. We have contingencies in place to facilitate this again in case we enter another lockdown. We also plan to continue to offer some courses and support remotely to participants who need to continue to "shield".

Covid 19
To ensure the safety of our staff, volunteers and participants, The Cart Shed has introduced measures in response to COVID-19 that all must adhere to. Our policies are amended as advice from the government is updated. If your answers to the below questions change prior to starting or during a course with The Cart Shed, we ask that the participant to let us know as soon as possible. Please read the statements below and check the boxes for all that apply.
Voluntary Contributions

From the feedback we receive we know how valued our services are by all involved in them. The Cart Shed charity relies on fundraising to enable those who do not qualify for social care support to attend sessions.


We are asking every participant to consider donating what they can to help with the costs of their course. This is not mandatory. If a participant cannot afford even the smallest of donations, we still welcome the referral. Donations and referrals are not linked.


Information on how participants can contribute will be given to them shortly after they enrol with us. Please make this known to you client, so it doesn’t come as a surprise. Information on how to donate will be given to the participant shortly after they enrol with us. 

Background information of person being referred











Reason for Referral

Relevant Background Information

Risk Assessment

Additional Documentation
Where relevant and possible please attach copies of EHCP’s, CPA’s, Crisis Plans, Care Plans and any other assessment or reports. 
Other Agencies involved (such as educational, medical or social services)








Referrer's Details










Address




Data Protection
The information that is shared with The Cart Shed during the referral process is requested in order to enable provision of appropriate occupational therapy assessment and intervention.  It will not be utilised in any other form than for the purpose for which it is collected. If it should become beneficial or necessary to share information with other healthcare professionals, social or welfare organisations this will be done in compliance with the Information Commissioner’s Office GDPR Regulations 2018. All information collected will be held securely.