All4one Information for Referrers: Thank you for making this referral. The group meets every Wednesday 4:30-8pm at the Powerhouse in Moss Side (M14 4SL). There is a shared meal each week (Halal / Vegetarian). There are occasional trips out such as to play bowling or go to the cinema. Young People joining the all4one group should have their own mobile phone. The young person should be confident in travelling to the city centre / Powerhouse on their own (or dropped off and collected by staff / foster carer) All4one contact number is 07421 312 170 (Becky - Wednesdays only). Please ask the young person to save this in their phone in order to receive messages about the group. If the number is not saved the messages don't get through (we use a whatsapp broadcast group). Referring Organisation Please search for the name of your organisation first Organisation Name * Phone Number * Email * Young person's details First Name * Last Name * Gender * - Select -FemaleMaleTransgender Birth Date * Day Day12345678910111213141516171819202122232425262728293031 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Year Year19221923192419251926192719281929193019311932193319341935193619371938193919401941194219431944194519461947194819491950195119521953195419551956195719581959196019611962196319641965196619671968196919701971197219731974197519761977197819791980198119821983198419851986198719881989199019911992199319941995199619971998199920002001200220032004200520062007200820092010201120122013201420152016201720182019202020212022 Street Address * City * Postal Code * Phone Number * Nationality * - Select -United KingdomAfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongo, Republic Of TheCongo, The Democratic Republic of theCook IslandsCosta RicaCôte d’IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly See (Vatican City State)HondurasHong KongHungaryIcelandIndiaIndonesiaIran, Islamic Republic ofIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia, Federated States ofMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussian FederationRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSerbia and MontenegroSeychellesSierra LeoneSingaporeSint Maarten (Dutch Part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyrian Arab RepublicTaiwanTajikistanTanzania, United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited StatesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Email Additional client fields Please provide reason for referral, background information, details of support needs and highlight any particular risks. Any known allergies? Dietary requirements First/home language * - Select -EnglishAcholiAmharicAlbanianArabicAzariBengaliBadiniBritish Sign LanguageCantoneseChewaCreoleDariDutchFarsiFrenchGeorgianGermanGreekGujuratiHausaHindiHungarianIbboKirundiItalianKimyaKoreanKurmanjiLesothoLingalaMandarinNdebeleNyanjaOromoPidginPolishPortuguesePunjabiPushtoRomanianRussianSorani KurdishShonaSomaliSpanishSwahiliTamilTigrinianTurkishUkrainianUrduVietnameseXhosaYorubaZuluOther Arrival date in the UK * Does the Young Person consent to their photo being taken? * Yes No Does the Young Person consent to video / photographs being taken and used by GMIAU. This may include publishing the photos / videos on the website and other forms of social media / marketing information Level of verbal English * - Select -NonePoorBasicFairly goodExcellent Immigration/asylum status * - Select -Claiming asylumAsylum refusedLimited leaveRefugee statusOther Social Worker First Name Last Name Phone Number Emergency Contact First Name * Last Name * Phone Number * Details of any other professionals involved. Leave this field blank