Teen volunteer emergency info and screening

We are delighted to work with local schools so that young people can experience Green Teens from the Green Hub Project for Teens.

Would you be kind enough to complete the following questionnaire, which will give us essential emergency / contact information, as well as more information about your teen’s situation. Together this will enable us to consider how we can fully support their needs.

We want to offer the best opportunity for your child to engage and enjoy being part of our team. Our volunteers have many skills but are not trained special needs or mental health specialists; please be aware that if, in some circumstances, we feel that Green Hub is not a suitable environment for a young person, we may have to say that we are not able to meet their needs.

We would like to reassure you that all information you share with us is stored safely (in a secure online environment) and will be handled with utmost confidentially.

Your Name *

Last Name *

Your email *

Your phone *

Child's name *

Child's birthday *

Child's preferred pronouns *

School *

Dates your child CANNOT attend during the next term?

Address1 *

Address2

Town *

Postcode *

Emergency 1 - contact *

Emergency 1 - relation? *

Emergency 1 - phone *

Emergency 2 - contact *

Emergency 2 - relation? *

Emergency 2 - phone *

Allergies (if none - say NONE) *

Medical conditions (if none - say NONE) *

Further information on medical conditions /allergies (if none - say NONE) *

In a few sentences, describe what's going on for your child at the moment - what are the major challenges they are facing?

1 Does your child have a diagnosis or possible diagnosis of ASC or ADHD (or other neurodivergent condition)? *

2 Does your child have an EHCP (Education Health Care Plan?) *

3 What type of school setting is your child in? *

4 Are they working at their expected age? How many years ahead/behind are they? *

5 If they are out of education, how long have they been so? *

6 Is your child able to work independently within a small group setting? *

7 Is your child likely to require 1-1 support most of the time? *

8 Would you consider your child to be a ‘flight risk’ if they become overly anxious or triggered? *

9 Does your child become aggressive towards themselves or others when they become dysregulated, anxious or triggered? *

10 What might trigger then to become overwhelmed or anxious? *

11 Do you feel that your child is able to keep themselves safe without 1:1 direct adult supervision? We are mindful that there are sharp tools accessible in the garden. *

12 Is there anything else you think we ought to be aware of? *

We will need to share this information with our adult volunteer team. Please check this box to give your permission. Without this, we may not be able to fully support your child. Yes, I agree

For more information about how we store your data, please see: https://greenhub.org.uk/privacy-policy/

Thank you for your help. We will come back to you with any specific comments or questions.