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Data submitted in this form will be processed in line with our BB4K Privacy Policy. You can also view a child-friendly version of the policy here.

If you have any problems completing the form, please get in touch with our team at

Step 1: Add details of parent/carer and referrer

Please fill in the details of the primary parent/carer for the child or children being referred and click ‘Save Details’. Then click ‘Add a child‘ to provide details of each child being referred. If this is not a self-referral, please also fill out the details of the referrer.

Useful tips:

  • Fields with a * are required and must be completed to submit the form
  • Postcodes must be all UPPER CASE with a space in between the first and second part
  • Mobile phone numbers must begin with 07 or +447 and contain no spaces
  • International phone numbers must begin with + and a valid country code and contain no spaces
  • If nothing happens when you click ‘save details’, please wait a moment as it can take a few seconds to save.

Important: Once you have completed this form, please click ‘Add a child’ at the bottom of the page to add details of each child referred for support.

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Important: Once you have completed this form, please click ‘Add a child’ to add details of the first child referred for support.

Without this information we will not be able to process the referral and we will have to get in touch with you to ask you to provide these details.

30% complete