Request a call back
Please complete the form to request a call back from one of our youth workers to check in and get connected. If you are in a crisis situation please use the following organisations for immediate support.
ChildLine Helpline (24 hour): 0800 1111
Samaritans Helpline: 116 123 (24 hour)
There is free online support and counselling at www.kooth.com
Please provide your name: *
Your answer
Age *
Your answer
Please provide the town you live in: *
Your answer
There are lots of youth centres in Devon, We have, some are not run by us directly but we have good relationship with the people who do. If you use one of those youth centres are you happy for us to pass your name and number to a youth worker from your nearest youth centre - even if its not run by Space? if not, no problem we can call you ourselves. *
Please provide your telephone number: *
Your answer
Would you prefer a phone call or text?
Please provide a brief description of what you would like to discuss: *
Nothing too private, just so we know if we need to look up some information before calling you back
Your answer
Please provide the times you are available for a call back: *
Required
By submitting this form you are giving us consent to store your details and use it to call you back. Please click below to confirm this *
Submit
Never submit passwords through Google Forms.
This form was created inside of [space*]. Report Abuse