Expression of Interest

Please complete the expression of interest here. So that contact can be actioned quickly please ensure you complete as much of the information as possible.

Fields marked with an * are required.

Key contacts

Tel: 01254 692709
Email: EHWB@canw.org.uk

    Details of Young Person

    Details of Parent (if under 16)

    Details of Referrer

    Is the young person currently a:

    YesNo
    YesNo
    YesNo
    YesNo

    Additional Information

    Privacy options: