Making your

Referral.

Referral to be made via School or LEA

Name of Student

UPN

Date of Birth

Year Group

Name and Address of School

School Contact/Role

Do you use CPOMS?

Do you use CPOMS Engage?

Name of Parent/Guardian

Relationship to Student

Name and Address of Parent/Guardian

Telephone

Additional Emergency Contact

Reason for attending BLGC

Any medical or allergy information

Transport arrangements to and from BLGC

Any additional information

Keep me up to date

I want to be kept up to date with all the latest news and updates from BLGC We will only contact you in relation to latest news & updates that we think will be of interest to you. We will not disclose your information to any third party and you can unsubscribe from our database at any time.

Consent

I understand that by completing and submitting this referral form, I am providing consent for the processing of my personal data in accordance with the General Data Protection Regulation (GDPR) and any applicable national data protection laws. I consent to the collection, storage, and use of the personal information provided in this form for the purpose of processing this referral and any related communications. I understand that my personal data will be handled securely and will only be shared with relevant parties involved in the referral process. I also acknowledge that I have the right to withdraw my consent at any time by contacting the data controller.

Email Address

education@blgc.co.uk

Phone Number

07787254982

Address

18 Spa Road Bolton BL1 4AG