CHARAVÉA MENTORSHIP ACADEMY

CHARAVÉA Application

Form

Section 1-Participant Details*

Date of Birth*

Age

School/College

Section 2- Parent/Carer

Relationship to Participant*

Email Address- Parent / Carer Details*

Parent / Carer Telephone Number*

Section 3- Select Programme of interest*

Foundation [Ages 9–13]

Formation [Ages 14–16]

Transition to Impact [Ages 17–20]

One-to-One Mentoring

Section 4- About the Participant

Section 5 -Support & Accessibility

Section 6- Safeguarding / Wellbeing

If you have an immediate safeguarding concern or the participant is in immediate danger, please contact the appropriate emergency or safeguarding service rather than relying on this form.

Section 7 — Consent

Parent/carer authority*

I confirm that I have parental responsibility or appropriate authority to make this application.

Consent to participate*

I consent to the participant taking part in the selected CHARAVÉA programme, subject to successful admission.

Communication*

I consent to CHARAVÉA contacting me about this application, programme arrangements and relevant participation information.

Safeguarding acknowledgement*

I understand that CHARAVÉA has safeguarding responsibilities and may need to share relevant information where necessary to protect a child or young person or where required by law.

Section 8- Declaration & Submission*

Parent/Carer Name*

Date*

Declaration text:*

I confirm that the information provided in this application is accurate and complete to the best of my knowledge. I understand that submitting this form does not automatically guarantee admission and that CHARAVÉA may contact me for further information if required.

Safeguarding acknowledgement*

I understand that CHARAVÉA has safeguarding responsibilities and may need to share relevant information where necessary to protect a child or young person or where required by law.

Thank you for your interest in CHARAVÉA Mentorship Academy. Please complete this short application so we can understand the participant and the programme that may be most appropriate for her.

© 2026 CHARAVÉA Mentorship Academy. All rights reserved.
A programme of Safer Care Pathways Ltd | Company No. 16862012

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Need help or have a safeguarding concern?
Email: safeguarding@charavea.org

If someone is in immediate danger, call 999.

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