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Bluebells

Katrina Martin / 2020VISION

Referral form

Refer someone else onto our Nature and Wellbeing service or The Bay wellbeing programme

Nature and Wellbeing referral form

Please use this form to refer someone else onto our Nature and Wellbeing service or The Bay wellbeing programme. If you have any questions, please don't hesitate to get in touch with a member of our team.

If you're looking to refer yourself onto a wellbeing programme, please use our self-referral form instead.

Self-referral form

To find out more about the different sessions we offer, scroll to the 'About our sessions' section on the Nature and Wellbeing webpage.

T: 01772 872007 or 07738 102274 (mobile)
E: natureandwellbeing@lancswt.org.uk or thebay-enquiries@lancswt.org.uk

Details of person being referred

Details of referrer

Has the individual consented to this referral?
There are a number of ways you can get involved with us. Please choose the option you would be most interested in from the list below.
Is being with a group of six people okay?

Known safeguarding issues

Risk to self

Self neglect
Self harm
Suicide attempt
Drug/alcohol misuse
Isolation

Risk/abuse from others

Physical
Financial
Sexual
Other

Risk to others

Is there potential for violent or aggressive behaviour?
Are there any concerns regarding safety to work alone?
Are there any concerns regarding safety to work alone in a group?

Risk to property

Theft
Damage
Other

Equal opportunities

In accordance with Lancashire Wildlife Trust’s policy on equal opportunities, we will provide equal opportunities to any participant and will not discriminate either directly or indirectly on the grounds of race, colour, ethnic origin, nationality, national origin, sex, sexual orientation, religion or belief, marital status, civil partnership, age, gender reassignment or disability.

We would therefore be grateful if you could complete the questions on this form. All information will be treated in confidence and is collected for project monitoring purposes only.
Gender
Ethnicity
Disability and impairment
Do you identify yourself as a deaf or disabled person?
Sexuality
Which pronouns do you prefer to be referred to as? This helps us to know the best way to address you.

For example: Your pronouns would be she/her if you'd like us to say, 'Yes, it's her bag, she left it here' in the event of you leaving your bag behind one day.
Referral next steps - who should we contact?
Are they under 18?
Please tick box to indicate.
We'd love to keep you updated with Lancashire Wildlife Trust news, activities and appeals. Are you are happy to hear from us in this way?
By signing up to our mailing list you are opting in to receive emails about events, local wildlife, campaigns, appeals and our further work We respect your privacy and will never sell your details, and you may change your preferences at any time. For more information about how we use your data please click here, and if you have any questions, please call 01772 324129 or email membership@lancswt.org.uk.

Please be aware that this information will be stored securely and retained at least until 31 December 2026, in compliance with the Data Protection Act 2018. For further information please click here to view our Privacy Statement or call us on 01772 324129.