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Short Breaks Enquiry Form

Use this form to apply for 100 hours Short Breaks. Once submitted you will receive a response within 12 weeks.

PLEASE NOTE - On receipt of your portal enquiry you will receive a confirmation email from the City of York Council Short Breaks Team. In the event that you do not receive this email your portal enquiry has not been received by the City of York Council's Short Breaks Team. In those circumstances please email earlyhelpshortbreaks@york.gov.uk  

Person making enquiry*
Part 1. Referrers Details
Preferred method of contact
Part 2. Family Details

Current address

Preferred method of contact