Daytime 1:1 Provision Referral Form

Section 1: The child being referred
Section 2: The referring agency
Name of referring agency and contact details of person making referral
Name and contact details of finance department for invoicing purposes
Section 3: The service requested

All 1:1 services are undertaken on a ’spot purchase’ basis and payment agreed in advance

1:1 Support Day Time Service - This service is available during school hours (term time only). Sessions are available between the hours of 8.30am and 3.00pm.

Preferred days and times: We will try our best to accommodate you but will be determined by staff availability.
Section 4: Payment Arrangements

Scale of Charges:
3 hour session: £90.00 (including lunch and activities)
4 hour session: £120.00 (including lunch and activities)
5 hour session: £150.00 (including lunch and activities)

Section 5: Contact details

Glenys James Mentoring Project Coordinator
[email protected]
020 7183 5120 Option 4/EXT 624