solihull.gov.uk

Holiday Activities and Food (HAF) Professional Referral Form

Section 1: Referrer details

* Name

* Organisation

* Role

* Email

Telephone

Section 2: Child details

* Child first name

* Child surname

* Date of birth (DD/MM/YYYY)

* Address

* Postcode

* Parent/carer email address

If you are applying for multiple children, you will need to complete a separate form for each child

Section 3: Eligibility criteria

Is the child currently supported under any of the following?

* Criteria child is receiving support through

If the child receives eligible support, please proceed to Section 6

If you answered 'No', please continue to answer the questions

Is the child currently supported under any of the following?

If the child does not receive one of the above options, you cannot proceed as they do not meet the referral criteria

Section 4: Parent or carer details

We need this information to complete a Universal Credit check if you selected:

SEND
young carer
elective home educated child
looked after child

Parent or carer first name

Parent or carer surname

Address

Postcode

Email address

Date of birth (DD/MM/YYYY)

National Insurance Number (e.g. AA123456B)

Section 5: Consent for a Universal Credit Check

I confirm that I have consent from the parent or carer for Solihull Council to verify their Universal Credit status to check eligibility for HAF and free school meals.

Section 6: Declaration

* I confirm that the information provided is accurate and that I am authorised to make this referral. Mandatory - I confirm that the information provided is accurate and that I am authorised to make this referral.

Data Protection

Your information may be shared with other council services and partner organisations to ensure our records are kept accurate and to help us to identify services or benefits you may be entitled to or interested in. We may also need to share your information for the prevention and detection of fraud and/or other crimes or as the law requires. For further information about how we use your information please refer to the Council’s Privacy Statement on www.solihull.gov.uk.