Referral Form 2026

REFERRAL FORM 2026

Thank you for your interest in referring a young person to one of our programmes. At 5 On It Foundation, we create safe, supportive and engaging spaces where children and young people can build confidence, develop new skills and feel a real sense of belonging.

Please complete the form below with as much detail as possible so we can ensure each referral is matched to the most suitable programme. Our team will review the information and be in touch to confirm next steps.

Young person's Full Name

Date of Birth/Age

Gender

Address

Address Line 1

Address Line 2

City

State

Zip Code

School/education setting

Year Group

Parent/Guardian Full Name

Relationship to young person

Telephone number *

Emergency Contact If Different from above *

Email *

Referrer Name *

Organisation name e.g. school, MK Council, TVP police *

Job Title *

Telephone *

Email *

How long have you known this person *

Reason for referral – tick all that apply

At risk of offending
Known to police
At risk of exclusion/already excluded
Low school attendance
Ant-social behaviour
Mental health concerns
Social isolation
Family challenges

Please describe why this young person would benefit from a 5 On It programme

Safeguarding information, is this person currently open to:

Social services
Early Help
Youth Offending Team

Name of lead professional if appropriate

Any known restrictions?

Any current safeguarding plans?

Known triggers or concerns

Medical information/allergies/diet

Consent and permissions – please tick

Participation in physical activity
First aid/emergency treatment
Photo/video consent
Data sharing

Programme suitability – what outcomes are expected?

Improved behaviour
Increased confidence
Better school engagement
Reduced risk taking

you known this

Ethnicity

Asian
Black
Caucasian
Mixed
Rather not say

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About

The 5 On It Foundation is a Milton Keynes-based charity dedicated to inspiring and empowering young people through innovative and engaging programmes. Focused on children and young people, the Foundation addresses key issues around health, education, and lifestyle by delivering impactful initiatives that are both informative and fun. These programmes are delivered by experienced, DBS-checked professionals who use sport, music, and the arts as powerful tools to engage participants, build confidence, and promote positive decision-making. The charity’s mission is to help young people make informed lifestyle choices and steer them away from negative influences.

At the heart of the 5 On It Foundation is a commitment to community wellbeing and youth development. By partnering with schools, local authorities, and community groups, the charity ensures its services reach those who need them most, especially in underserved areas. Every session is carefully designed to be inclusive, culturally relevant, and responsive to local needs, ensuring maximum impact. Through a combination of creative expression and physical activity, the Foundation delivers serious messages in a way that resonates with young audiences, leaving a lasting impression that supports personal growth and community cohesion.