Make a referral below

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 any references or supporting agencies during the assessment process. If we feel that a placement will trigger or exacerbate any risk or support needs and have a detrimental effect on yourself or the hosts, we may not be able to arrange a placement. We will look at all referrals 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. If a referral is sent after 3pm, we will try our best to complete for placement that day but cannot guarantee same day placement.

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.

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

Please complete this information about the professional completing this form.

Please complete this section about the young person being referred.

These questions help us assess your suitability to a nightstop placement and ensure that you and your potential host(s) are safe if you stay with them. If a section applies, please give as much information as possible including the history, how it affects your day-to-day life, what you currently do about it and any challenges you face. This also allows us to know what support you need.

Reference 1

Reference 2

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

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.

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’.

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.

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.

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

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

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.

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)

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.

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: