E S C A Y P™
Emotional Support for Children And Young People

Patron: Mr. Paul Wombwell
Registered Charity Number 1127715

You can also fill out and send the form in the post. You can print it Here.

Information about the Child or Young person being referred










Kirklees
Leeds
Bradford
Wakefield
Calderdale
None



Male
Female









Yes
No












Yes
No



Yes
No



Yes
No



Yes
No






Information about the person making this referral
























Young person’s main carer















Yes
No






Yes
No





Yes
No





Yes
No





Yes
No








Yes
No















All counselling is carried out on a 1 to 1 basis.

Please note:

Any information given by the referrer may be shared with the young person. All information from the young person will be confidential, but will be within the guidelines of the Child Protection and Safeguarding Board and the British Association for Counselling and Psychotherapy (BACP).