Initial Planning Meeting Name*Mobile*ReferrerDOBInitial Meeting Date*Time*AttendeesLocation 1st WENWHES completed?*YesNoAny change in your contact details since referral?*YesNoIf yes, please tell us?ScoreSafeguarding?*YesNoRisk Planning?*YesNoAbout youYou / Your family & friends / School, training, or work / How active are you? / Current or past activities / What brought you to US? / Your mental health / How does how you feel affect what you do? / How do you feel about getting active? Do you know why we encourage young people to get active...?Because getting active can: • improve mental and physical health • increase confidence and self esteem • improve social skills • improve engagement in education, training and employment • improve ability to get involved in other life activities And so, we want to help young people adopt it as a lifestyle tool to help them throughout their lifeActivity Options*Fitness activity / Type of sessions / Availability / Transport / What to bring Support to get you involved*Things you’re worried about / Things you need to know / Who will be involved / Disabilities, medication, allergies / Communication methods / Travel / Clothing Keeping you and others safe SafeguardingRisk ManagementWhat do you hope to gain by getting involved with US and our activities?Short term - with US / Long Term - to keep activeProposed PlanShort term - with US / Long Term - to keep activePersonal GoalsMy Personal Goal - 1*My Personal Goal - 2My Personal Goal - 3How will I know if I've achieved my personal goal?How will I know if I've achieved my personal goal?How will I know if I've achieved my personal goal?What actions do we need to do to make it happen?Progress Catch upWhen we'll catch up What time we'll meetWhere we'll meetRe-checking your consentFirst Aid and Emergency treatmentYesNoInformation on other relevant US ActivitiesYesNoUS Mailing ListYesNoPhoto / Media permissions re. ActivityYesNoPhoto / Media permission for general marketingYesNoSignature to confirm we agree with recorded planYoung PersonParent / CarerUSPlease enable JavaScript to submit this form.SendThis field should be left blank
