Serious Illness Referral

Request support from SeeSaw when someone is seriously ill

Please complete the referral form below if:

• You would like to request support for a child or young person where a parent or sibling is dying
• You are a young person and would like to request support

A member of staff will contact you within 48 hours (working days Monday to Friday) to discuss what support SeeSaw may be able to offer.

Do you have permission to request support for this family?

Your name

Your address

Your telephone number

Your email address

Your relationship to the child/children

Please tell us who is ill

Please tell us the nature of their illness

What is their relationship to the child/ren?

Child's first name

Child's surname

Child's date of birth

Child's gender

Ethnicity of Child

Child's school (if applicable)

Add another child

Child's first name

Child's surname

Child's date of birth

Ethnicity of Child

Child's school (if applicable)

Add another child

Child's first name

Child's surname

Child's date of birth

Child's gender

Ethnicity of Child

Child's school (if applicable)

Add another child

Additional children's details

Please give brief reasons why you are contacting SeeSaw e.g. support for expected bereavement, general information

What is your first/main language?

Why are we asking about your ethnicity and languages you speak?
SeeSaw uses this information to check that the service we provide is being accessed by all ethnic and community groups represented in Oxfordshire, and it helps us be aware of any communication support needed. We will regularly review this data to ensure that our service is relevant, accessible and appropriate to all and make changes if we become aware it is not.

To help us give advice and keep in contact with you we need to record and store some information about you and your family. Can you confirm you are happy to go ahead on this basis?

For more information on how we store your information you can read our Privacy Policy here