Making Memories… Giving Hope

Refer a Child on a CHICKS Break

Refer a Child on a CHICKS Break

Who can refer?

Anyone that works with a child in a professional capacity can refer them for a five day residential respite break. 

Agencies that currently refer to us include Social Services, schools, youth groups, churches, Young Carers' groups and community centres amongst others. 

The professional must know the child to make the referral. Before a child is booked on a break a CHICKS coordinator will conduct a telephone assessment with this professional and this will cover the reasons why the child has been referred as well as any behavioural or medical needs the child has. It is important that this person is able to answer these questions with as much detail as possible to allow CHICKS to make a decision as to whether it is the right support for each child. 

This professional will be asked to agree to be the main contact between CHICKS and the family, to provide sufficient 24 hour contact information while the child is on the break and to organsie suitable transport and supervision to and from our pick-up points. 


Children must be aged between 8 - 15 years old. Children are welcome back each calendar year (depending on the previous break report and suitability) but they may only attend once per calendar year. 

Children can be referred to CHICKS for a huge variety of reasons. They may be living in poverty, be young carers or be subject to neglect, bereavement, abuse, emotional distress or any other situation that causes the child to have a tough time at home.

For more information, including criteria for referral please check our FAQs. 

Referral Process

Please Note, submitting a referral does not guarantee a space on a break. We receive more referrals than we have available spaces. 

  1. Complete an online 2018 Referral Form. 
  2. Telephone Assessment - when CHICKS feels they are able to offer a space to the child(ren) you have referred they will call you to conduct a telephone assessment. This is the point at which you will know whether the child has a break with us or not. 
  3. Consent Form - if successful, you will need to inform the family and get a 2018 Consent and Medical Form signed by the child's legal guardian. 
  4. Transport Form - CHICKS will provide you with a form with the different pick-up and drop-off locations and times. 

2018 Breaks

We require a new referral each calendar year and our 2018 referral form is now active. Please see below a list of our Spring break dates and our 2018 referral form. 

2018 Spring Break Dates 

2018 Break Referral Form

Please also find our Consent and Medical form which needs to be hand signed by the child's legal guardian. 

2018 Consent and Medical Form 

Please note, submitting a referral does not guaruntee a break place being allocated. Unfortunately, we receive more referrals than we have spaces.

Group Bookings

If you would like to discuss booking a group of children, then please get in touch with the team using the contact details below. 

Any more questions?

Please check our FAQs and our Referral Guide in the first instance. If you have any further queries that aren't answered here, please get in touch: or call 01822 811020.

"CHICKS breaks are a source of pure, uncomplicated happiness for a child who has had some difficult experiences."  Referral partner, Hackney