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Keepers Gate Forest School Alternative Provision Referral Form

School/Organisation name and address;

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Contact member of staff/job role;

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Email address

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Child's name being referred;

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Child's date of birth;

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Child's gender

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Child's ethnicity

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Child's condition, disability details or medical conditions

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Reason for referral- include school status, outcomes and behaviours

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Child attendance at school- hours and days

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Does the child have any ACE's?

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Please attach the child's EHCP if they have one.

Size limit: 10 MB