Contact us – U-Turn

Peer Education Service:
partner referral form

U-Turn’s Peer Education Service will work with young people 12 – 18 years from across South Lanarkshire. This service will work with young people to design, develop and deliver a harm reduction programme on substance across all 4 South Lanarkshire localities.
If you are working with a young person who may be interested in taking part in our service, please fill in this form and a member of the team will be in touch to register a young person to the service.

Participant Details

Date of Referral *

Date of birth *

Participants Name *

First

Last

Contact Number *

Address (including postcode) *

Referrer Details

Name *

First

Last

Reason for Referral *

Organisation *

Contact Number *

Involvement with any other services

I give consent for Glasgow Council on Alcohol’s Peer Education programme to store my submitted information on this form so they can respond to my enquiry. I declare that I have the permission from the participant to share the information on this form with Glasgow Council on Alcohol’s Peer Education programme. I give consent for Glasgow Council on Alcohol’s Peer Education programme to share information with partner(s) referring me onto this programme. I agree that GCA and its partners may share information for funding purposes. This information will be minimised where possible. I declare that information that I have given on this form are correct as far as I know.

Participant Signature: *

Referrer Signature: *

Date *

Peer Education Service: partner referral form

Participant Details

Referrer Details

U-TURN

Peer Education Service:
partner referral form