Referral form- inclusive wellbeing groups
This form is for families and professionals to request a space in one of our Inclusive Wellbeing groups.

Who is the service for? 

● Children in year 1 and above

Who is not suitable for the service? 

● Children requiring personal care or toileting support

●  We may not be able to support some children with highly complex medical or learning needs.


Sadly, not everyone who asks for a place will get one. 


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Email *
Your name, contact number and relationship to the child

 *
Child's name and age *
Reason for the referral  *
Required
Further information about the referral 

Things to include: safeguarding issues, childhood trauma, additional needs and anything you feel is relevant.
 *
What type of session are you looking for? *
Required
May the child require 1:1 support?  *
If yes, why do you think 1:1 support may be needed?
Have they attended Mud Pies before? If so, what group did they come to?

What will happen now? 

This form will be sent directly to our team. We aim to respond within 10 working days.

If you have any questions please email rachaelp@mud-pies.co.uk

Sadly, not everyone who asks for a place will get one. 

A copy of your responses will be emailed to the address you provided.
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