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Daystop referral form

Daystop is a service available to young people aged 16-25 years, who are homeless or at risk of homelessness. To proceed with the referral, we need you to have read the privacy notice, signed the authorisation form and the referral. These will come up as you progress with the form. This form allows us to determine whether a placement with nightstop is suitable for you, but also allows us to know what support you need. We ask questions about your current circumstances and any support needs you may have and assess whether this is something that can be managed during a placement. We will speak with you and your referrer during the assessment process. We access to Daystop on a case-by-case basis. We cannot accept anyone that is high risk to themselves or others, have committed serious, violent, or sexual crime or have a history of arson.

Authorisation for request of Information

I confirm that I have read and understood the Gloucestershire Nightstop privacy statement for young people. I hereby authorise Gloucestershire Nightstop to make enquiries about me including requests for personal data, special categories of personal data (including health) and data relating to criminal activities and convictions. I give my full and unreserved permission to all individuals, organisations or agencies ticked below to forward to Gloucestershire Nightstop any information including special category data and data relating to criminal activities and convictions that may be requested by them. I understand that Gloucestershire Nightstop will not ordinarily divulge any of my data or information to any third party other than in keeping with the processes detailed within the Gloucestershire Nightstop Service users Privacy Notice and Gloucestershire Nightstop Safeguarding procedures. I understand that I can withdraw this consent at any time through contact with staff at Gloucestershire Nightstop.
I consent to Gloucestershire Nightstop making enquiries or requesting information about me in order to process my referral
DD slash MM slash YYYY
This can be signed virtually on behalf of the young person, where this referral is carried out remotely. Please check the box below to confirm who has signed and that the young person has given their consent to process this referral and understands the information above.
Signed on behalf of Young Person?(Required)

Note-

If the young person has not given consent please go back to the young person and discuss the information sharing above before proceeding.

Referrer Information

Please complete this information about the professional completing this form.
Name of Referrer

Referral Information

Please complete this section about the young person being referred.
Name
DD slash MM slash YYYY

Current circumstances

Mental health concerns, physical health issues, offending history, or anything that may pose a risk while using daystop services?

Declaration

I declare that the information provided on this referral form is correct and true(Required)
MM slash DD slash YYYY
This form can be submitted by email (please ring 01452 331330 for the email of the person on duty that day). Please ring to confirm receipt after sending. Please ensure the authorisation form and the declaration has been signed. This can be done digitally if completing a referral over the phone. Without these we are unable to process the referral.

Who are we Gloucestershire Nightstop?

Gloucestershire Nightstop is a charity that provides accommodation and support to young people aged 16 – 25 across the County of Gloucestershire.

Collection of personal data

When you are working with us we will process a range of personal information about you which includes name, contact details, age and emergency contact details. We also process special categories of information about you which includes but is not limited to health, ethnicity, offending and equalities information. This will be used only for the purposes of providing and developing our services and is not shared with third parties unless you have agreed to this or if we believe you or someone else is in danger.

Where do we get your information from?

We collect your information through our referral forms, our assessments with you and conversations we may have with other people about you. Our lawful reasons for processing your information are ‘legitimate interests’ and ‘consent’.

What we do with your information?

We will use your information for the following purposes: To enable us to assess whether you are suitable for our service. To enable us to make you appropriate offers of services and to safely manage those services. To enable us to offer you 24-hour support while you use our Nightstop services. To enable us to work with you toward move on accommodation and accessing other services. To enable us to effectively safeguard you and everyone associated with delivery of our services We may use your personal data without your knowledge or consent where we are permitted or required by law or regulatory requirements to do so.

Sharing your information

Some of the information we hold about you will be shared with our volunteers when we offer and make a Nightstop placement or other services. Volunteers will only be given the information they need to keep both you and them safe. We will also share your information with third party agencies to help you with housing and associated issues. You will normally have consented to this. When we share personal information with these parties, we require that they only use or disclose personal information in a manner consistent with the use and disclosure provisions of this Privacy Policy.

Monitoring

As part of our internal processes, we will also monitor electronic communications sent to and received from service users.

Keeping your personal information safe and secure

While we hold your information, we will make sure that it is safe and cannot be accessed by third parties.

Updating your personal information

To enable us to provide you with the right service and to help us comply with data protection legislation, we ask that you keep us up to date with any changes in your personal data.

Your rights and how to access your personal information

Under GDPR you have a number of rights over the way we manage your information. Right to be informed: we will not collect your information without you knowing, you have the right to be informed of what data we are processing, what for, how we obtained it and to whom it is released Right to access: subject to certain conditions, we will give you access to the information we hold on you Right to rectification: we will correct information about you that is wrong Right to erasure: we will erase information we hold about you (except in some circumstances) Right to restrict processing: we will stop using your information your request (in some circumstances) Right to portability (where appropriate)

How long we will keep your data?

There are some legal and regulatory requirements that which tell us how long we should keep hold of personal data. Beyond this we will keep your personal information no longer than is necessary to ensure that we are able to provide you with appropriate services and support. After you have left our services some of your information will be retained for up to two years.

Further information

If you have any questions about this or want to contact us you can speak with the Data Controller Elaine Pearson at our office via: Telephone: 01452 331330 Email:
I have read the Gloucestershire Nightstop privacy policy and agree to my information (including special category data) being processed in accordance with that statement(Required)

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Contact us

13 Ladybellegate Street,
Gloucester
GL1 2HN

Phone: 01452 331330
Email:

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