Make a referral to Making Changes

Service access criteria

Tick to confirm you have checked the service access criteria "Privacy Statement You can withdraw your consent at any time by emailing making.changes@blackpool.gov.uk.  For further information on how your data is processed as part of the programme, please see our privacy statement below. Active Blackpool are the data controllers for the personal information you have provided in this form. The Council’s data protection officer can be contacted at Dataprotectionofficer@blackpool.gov.uk or by writing to Data Protection Officer, PO BOX 4, Blackpool, FY1 1NA.   In relation to the privacy statement, further information is available on our website at www.blackpool.gov.uk/PrivacyNotices  The child & family management service requires personal data to ensure we provide you the best possible service.    The personal information on this form will be retained to demonstrate that consent was sought for the named person above and their family to take part in this programme.  We will use the information provided to contact you in an emergency and ensure that staff delivering the sessions are aware of any medical or special support needs.  The lawful basis for the Council to collect and use your personal information is because you have given us clear consent.  We will collect the following information: your name, date of birth, medical information, contact details, medical history, height/weight/BMI and details of any medication.  Your data will be stored securely and reported anonymously to Public Health.  We do not transfer your information to a third country (that is a country outside of the EEA)."

Your Details

Who are you referring?

Don't know / client doesn't have an email address

Additional referral details

Other:

Confirmation and consent

Tick to confirm you have gained consent to share this information with the service provider, your organisation and Joy
Tick to confirm the service provider can directly contact the client

Would you like to create an account?
Make referrals faster next time you use Joy. Registered users can message service providers, submit reviews and track the progress of their referrals online.

required