If you would like to make a referral for the 25th December 2020, please complete this form.

Christmas 2020 - Referral Form
For the referral of Service Users by agencies and professionals
The information you submit will be kept in accordance with the Data Protection Act 1998. Please see https://www.ukeff.org/privacy-policy/

By signing this form you are confirming that the Client is aware of, and consents to, this referral and that we (UKeff) can share all information contained in this form with the Client.
The Client also consents for us to contact them directly to offer support and assistance and to maintain future contact with the referrer if the need arises.

UKeff is committed to equal opportunities and seeks to assist individuals from all sectors of the community. UKeff will not tolerate the less favourable treatment of anyone on the grounds of their gender, age, race, colour, nationality, ethnic or national origin, disability, marital status, sexual orientation, responsibility for dependents, trade union or political activities, religious or other beliefs, or any other reason which cannot be shown to be justified. This policy is subject to the requirements and legislative framework as outlined in the Equality Act 2010.
If roughsleeper or homeless, please provide hostel details or other contact point
If available
Please state the name, date of birth, gender and relation to the Primary Service User (eg child, spouse) who will be attending with the client
Please select if a food parcel is required
Please detail any other required support for the Service User
Office telephone number
Mobile number
Please select all that apply
Please add the relevant details for your referral
If the SU is unable to attend the Unitarian Chapel on Christmas Day, will a home delivery of food and a well-being check be required?
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