Sussex Against Bullying

Click here to edit subtitle

Young Persons Name
Name Of Person Making The referral
Email Address
Phone Number
Organisation (If Appropriate)
Young Persons Address 1
Young Persons Address 2
Postal Code
Parents Name
Parents Contact Number
Any Additional Needs?
Young Persons D.O.B
Gender
Is your child currently experiencing bullying
What forms of bullying has your child experienced
- Physical
- Verbal
- Social
- Cyber
Please Tick All That Apply
- The Young Person has started taking time off school because of bullying
- The young persons confidence is being affected by bullying
- The young person has a low opinion of themselves because of bullying
- My child is becoming isolated as a result of the bullying
Send Message

Thank you for your referral. We will get back to you with in 2 working days

Oops. An error occurred.
Click here to try again.

If you want to discuss a referral please contact Youth Club Manager Benjamin Checkley 07517991309 Or Email [email protected]

More info on our projects is available on our 'Youth Projects' Page

If your child is worried about joining, but wants support, please do contact us as there are ways we can support your child.