Leeds Mencap Playschemes 2015

Information

Leeds Mencap is planning three weeks of playscheme during summer 2015.

Week 1 27th to 31st July, playscheme for children aged 9 to 13 years

Week 2 3rd to 7th August, playscheme for young people aged 14 to 18 years

Week 3 10th to 14th August, playscheme for children aged 4 to 8 years

In weeks 1 and 2, we are working with John Jamieson School, East SILC. The playschemes will take place at the school:

John Jamieson School
Hollin Hill Drive
Leeds, LS8 2PW

The playschemes are open to all children with learning disabilities in Leeds, but some places are reserved for John Jamieson’s pupils.Children who attend John Jamieson should apply to Leeds Mencap for a place in the same way as everyone else.

Week 3 will be at our office in East End Park and is open to all children with learning disabilities in Leeds.

Closing date for applications for all playschemes is 23rd June 2015. We will not accept applications after this date. Places will be confirmed on receipt of full payment and a completed application form. The charge for attending the playscheme is £15 per day (£75 for the full week). Cheques should be made payable to: Leeds Mencap.

If we are oversubscribed, we may offer a reduced number of days to make sure all the children who apply can attend.Confirmation of places will be sent out in writing. No young person will be accepted on the day without prior booking.The playscheme will start at 10.00 am and finish at 3.00pm. Young people will need to bring a packed lunch with them every day.

If your child cannot attend due to illness please contact Leeds Mencap’s day time telephone number which is 0113 235 1331. Unfortunately we are not able to refund payment for days which children do not attend (e.g. because of illness).

Please return your playscheme application form and payment to:

Leeds Mencap, Londesboro Terrace, East End Park, Leeds, LS9 9NE

Or, by emailto:

Please retain this sheet for your information.

Week 3

Which days would you like to apply for?

Monday / Tuesday / Wednesday / Thursday / Friday

The playscheme for this week has been provided with a reduced budget for activities and outings.

As well as all the usual on-base activities and free attractions in the local area, we would like to know whether you would consider paying an additional fee for the group to go on a day trip to Hesketh Farm or a similar venue.

The cost of the trip would be £7 for entrance fees and a £10 contribution to the cost of transport, £17 in total.

Please can you answer the following questions:

  1. I/we would be prepared to pay towards to costs of a day trip during playscheme.

Yes/No

We would like to know your views on this model of playscheme delivery. It is different to what we have done before and we would like to hear your opinions on how best to run good playschemes with the changes to funding.

  1. I/we would be interested in coming to a meeting to discuss the changes?

Yes/No

Your name:

Contact number and email address:

Thank you

Playscheme Application Guidance

To apply for a place at the Leeds Mencap summer playscheme, you must complete the following Referral Form for Targeted Short Breaks.

This form has been produced by the Leeds City Council Placement Service to be used by all Targeted Short Breaksservice providers,and some of the questions asked on it are not relevant to the Leeds Mencap Playscheme. If you are applying for the Leeds Mencap Playscheme only, please follow the guidance below when filling in the form and send it directly to Leeds Mencap

  • Section 1 – complete this section
  • Section 2 – optional
  • Section 3 – complete this section
  • Section 4 – answer all questions except q3 and q5
  • Section 5 – complete this section
  • Section 6 – complete this section
  • Section 7 – complete this section
  • Section 8 – complete this section. Use q3 to tell us you are applying for playscheme
  • Section 9 - complete this section

If you would like to apply for other Targeted Short Breaks services as well, please complete the form in fulland send it to both Leeds Mencap and to the Leeds Placement Service(see details on the first page of the form).

Remember, the form is all about the child or young person with a disability, so when it says ‘you’ it is directed to the child/young person – not to the parent or carer.

If you would like more information about filling in the form, please call Leeds Mencap on 0113 2351331 or contact the Family Placement Service for help and advice.

This document is also available in Braille and large type. Please let us know if you require help with translation

Referral form for Targeted Short Breaks

To be completed by child/young person with their familyor carers

Completed forms can be sent directly to your Targeted Short Break service of choice. Details of what is available can be foundby going to the Leeds Local Offer website: ().

Or alternatively forms can be sent to

, Placement Service, Kernel House, Killingbeck Drive, Leeds, LS14 6UF, tel: 0113 37 83775, who can help you decide the most appropriate service.

If you would like information, advice and support to access inclusive mainstream services, please contact Scope in Leeds (tel: 0113 272 7531 or 0800 085 1879).

Section 1: Key Details

Your name: / Your date of birth: / Date form completed:
Who else lives in your home? Do they have any needs or access any services? / Your School/Nursery:
Your Lead Professional
and their
contact details:
Your Social worker:
and their
contact details:
Your home address: / Emergency contact:
If anyone has helped you complete this form, please list here:
Home Phone number : / Preferred language:
Mobile Phone number:
Email Address:
Parental Responsibility held by

Section 2:All about you

(Please describe yourself, for examplewhat you like/dislike, activities you get involved in,what you are good at, what you are interested in, your hobbies, any dietary needs,cultural/religious needs, what makes you feel anxious or upset)
(Please include a picture of yourself if you would like to)

Section 3: Please tell us a little bit more about yourself to help us understand more about you.

  1. Please tick one of the following categories, which best describes you:

Your Ethnicity / Code / Please Tick / Your Ethnicity / Code / Please Tick
White British / WBRI / Pakistani / APKN
White Irish / WIRI / Bangladeshi / ABAN
Traveller of Irish Heritage / WIRT / Any other Asian background / AOTH
Any other White background / WOTH / Caribbean / BCRB
Gypsy/Roma / WROM / African / BAFR
White and Black Caribbean / MWBC / Any other Black background / BOTH
White and Black African / MWBA / Chinese / CHNE
White and Asian / MWAS / Any other ethnic group / OOTH
Any other Mixed background / MOTH / If other ethnic group please state which
Indian / AIND / Refused / REFU
Information not yet obtained / NOBT
  1. How would you describe your disability?

  1. Do you have a Statement / Education, Health and Care Plan (EHCP)?

  1. Do you have an Early Help Assessment (also known as a CAF)?

  1. Medical information:
Do you have any medical needs, such as medication you take, epilepsy including patterns of seizures or other health related conditions? /
  1. Do you have any allergies that a setting may need to know about?

If yes, please explain what they are: / If yes, please explain what they are:
  1. Communication needs:
How do you communicate? Verbal? Non verbal? BSL, Makaton?
Does you use signs or symbols (for example, board maker, Picture Exchange Communication)?
If you communicate non-verbally,is body language, eye pointing, or other forms of communication significant? How do you communicate with the person who looks after you, and at school?

Section 4: Day to day needs

1.Are you able to get around the house and elsewhere by yourself?

/ Not at all /
With help
/
Without help
Is there anything else you want to tell us?:

2.Are you able to feed yourself?

/
With help
/
Without help
Is there anything else you want to tell us?:
  1. Are you able to wash / dress yourself?
/ With help / Without help
Is there anything else you want to tell us?:
  1. Are you able to use the toilet by yourself?
/ With help / Without help
Is there anything else you want to tell us?:
  1. Bedtime

What time do you - / Go to bed? / Wake up? / Do you need any attention through the night?
Yes / No
What do you like to
do before you go
to sleep?
Is there anything else you want to tell us?:
  1. Do you have any needs in relation to your Hearing?

Please tell us about this:
  1. Do you have any needs in relation to your Speech?

Please tell us about this:
  1. Do you have any needs in relation to your Sight?

Please tell us about this:

Section 5: Behaviour and skills

  1. Please tell us about your skills and achievements:

  1. Do you enjoy being with other children and adults? If you have any difficulties please tell us.

  1. Do you have friends or family you like to be with?

  1. How are things at school, nursery or college?

  1. Tell us about anyworries, fears or obsessions that you may have

  1. Are you very active or find it hard to sit still?
/ Yes / Occasionally / No
Comment:
  1. Do you need/like lots of attention from others?
/ Yes / Occasionally / No
Comment:
  1. Do you sometimes wander off or make a run for it?
/ Yes / Occasionally / No
Comment:
  1. Do you ever injure yourself or others?
/ Yes / Occasionally / No
Comment:

Section 6: Support

How can we help you to manage any of the issues from sections 4 and 5?
Comment:

Section 7: Anything else about you we should know?

  1. Would you or your family like to tell us anything else, which may assist us?

Section 8: Short Breaks

  1. Are you accessing any short breaks now?
If yes, please tell us about them:
  1. What have you tried and has it worked for you and your family?

  1. What types of short break are you interesting in accessing?

  1. What difference will this make to you and your family?

  1. Which times/days would be preferred for short breaks?

Daycare / Weekdays / Weekends / Full weeks
Yes / am / pm / Yes / Yes / Yes
No / am / pm / No / No / No
Other/comments:

Section 9: Consent

Data Protection Act 1998

In accordance with the Data Protection Act 1998, we must inform you that by signing this form you are giving your consent for Leeds City Council children's services to process the information we collect from you now and whilst we have involvement with your family. The purpose of this processing is for the provision of targeted short breaks for your child/children. This information may be shared not only with other areas within Leeds City Council, but also with other relevant professionals and organisations, such as the NHS and short break providers, however only where necessary and appropriate. This is to enable us to signpost you and your family to suitable services. This sharing will be done only where it is necessary or where we are legally obliged to do so and is strictly in accordance with the Data Protection Act.

Your information may be collated, anonymised or monitored to ensure you receive the correct support and may assist with future planning of services in Leeds.

If you have any queries regarding information sharing please contact your lead practitioner in the first instance.

Name of child/children

Name of parent/carer

Signature

Date

For office use only:

Disability Type / Code / Yes/No / Disability Type / Code / Yes/No
Specific learning difficulty / SPLD / Visual impairment / VI
Moderate learning difficulty / MLD / Multi-sensory impairment / MSI
Severe learning difficulty / SLD / Physical disability / PD
Profound & multiple learning difficulty / PMLD / Autistic spectrum disorder / ASD
Social, emotional and mental health / SEMH / Other difficulty / disability / OTH
Speech, language and communication needs / SLCN / SEN support but no specialist assessment of type of need / NSA
Hearing impairment / HI

To be completed by designated worker and line manager where relevant:

Name and signature of designated worker completingessential information / Date
Job title and organisation of designated
Worker
Contact details of designated worker
Name and signature of line manager / Date
Job title and organisation of line manager
Contact details of line manager

Form version: April 2015

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