Nudge Education Referral Form
This form is used to initially refer a student to us. It really helps us to build a picture of the student and begin the matching process at an early stage if you complete this as thoroughly as possible. All data is stored securely on our system and in line with current General Data Protection Regulations (GDPR).
By Completing this form, I am confirming that I have the relevant authority to commission Nudge Education to work with this student. *
Your Name *
Your answer
Organisation Name *
Your answer
Position in Organisation *
Your answer
Contact Phone Number *
Your answer
Email Address *
Your answer
You (the Commissioner) agree to a NUDGE Education Expert providing basic first aid in the event of a minor injury such as scrape or cut when not in the presence of a first-aider. The basic first aid kit will contain non-alcohol cleansing wipes and non latex plasters. For any major injury or emergency situation, NUDGE education experts will call the relevant emergency service. *
Photographs and Videos may be taken of the student's work to use as evidence of progression and engagement. Occasionally this media may contain images or video of the student. You (the Commissioner) give consent for this media to be included in the student's portfolio. Should we require further parental/carer consent, you will agree to collect this or ask Nudge Education staff to collect this on your behalf. Under no circumstances will this data be used by third parties or in promotional materials by NUDGE. *
You (the Commissioner) agree to the provision by NUDGE in off-site visits and excursions which may benefit the student for both educational and enrichment purposes. Transportation will be provided to such excursions where required and a full risk assessment will be carried out as per NUDGE's health and safety and safeguarding policies. *
Nudge Education has a policy of positive handling and will only use physical intervention as a last resort. Each student will have their own personalised learning plan and pen portrait that will identify their own specific support requirements. By signing this agreement I/We (the Commissioner) agree to the appropriate positive handling and physical intervention of the student by a trained professional. *
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