Home Cooked Registration Form

Home Cooked consortium is focused on reducing youth violence in Northumberland Park by offering support to young people, parents and carers. This includes mentoring, training, and employability support for young people, and supporting parents to navigate Special Education Needs systems and tailored parenting support. Following referral, Home Cooked will direct the referred young person to the appropriate service. They may contact the referrer or the referred person for further information. Referrals can be made by parents, professionals, teachers and young people themselves (aged 14+). You will receive an email confirmation, and then a member of the Home Cooked team will be in touch within 3-5 working days to talk to you about your support needs.

Who are you referring for?

What services are you referring from? (leave blank if you’re not a professional)

What is your name? (required)

What is your email address? (required)

What is your mobile phone number? (required)

What is your/ the young person’s age? (not needed if you are a parent referring for yourself) (required)

What is your/the young person’s gender? (required)

What is your/the young person’s ethnicity? (if you are a parent looking for support for yourself please answer for yourself)

Asian or Asian British - IndianAsian or Asian British - PakistaniAsian or Asian British - BangladeshiAsian or Asian British - ChineseAsian or Asian British - any other Asian backgroundBlack or Black British - AfricanBlack or Black British - CaribbeanBlack or Black British any other Black backgroundMixed Heritage - White & Black AfricanMixed Heritage - White & Black CaribbeanMixed Heritage - White & AsianMixed Heritage - any other ethnic backgroundWhite: BritishWhite: IrishWhite: Gypsy, TravellerWhite: any other White backgroundOther Ethnic Group: ArabOther Ethnic Group: any other ethnic backgroundPrefer not to say

What are the first 3 digits of your postcode? (required)

What school do you/the young person attend?

What are your/ the young person’s support needs? (required)

Community mentoring for a young person at risk of violence or disengagementEngage young people in positive sporting opportunitiesEmployment pathways for young people, including those with justice system involvementTherapeutic mental health support for young peopleN/A (I am a professional)

Do you/the young person have any type of disability? (select as many as apply)

Physical disabilityMental health needSpecial Educational Needs and Disability (SEND)Education, health and care plan (EHC plan)OtherNone

If you ticked you have a disability, please give details of your/their condition (s) here

As a parent, what support do you need

My child’s behaviourNavigating Special Education Needs Services in HaringeyN/A

How did you hear about the service? (required)

From Godwin Lawson FoundationFrom North London Partnership ConsortiumOpen DoorFrom Tottenham Hotspur FoundationFrom the Bridge Renewal Trust Home Cooked teamThrough Home Cooked’s social mediaFrom my friend or familyFrom my schoolFrom the policeOther Bridge Renewal Trust Services From the Bridge Renewal Trust BulletinI attended a previous event Other From another statutory service

I give permission for the details I have given in this form to be shared with the relevant partners involved in the services I have requested

Yes No

How else would you like to be contacted

I would like to receive the Home Cooked newsletterI would like to receive the Bridge Renewal Trust Newsletter I would like to be added to Home Cooked Events database