Short Breaks Enquiry

If you require help completing this form please contact fis@york.gov.uk or telephone 01904 554444.

PLEASE NOTE - On receipt of your portal enquiry you will receive a confirmation email from the City of York Council. In the event that you do not receive this email your portal enquiry has not been received by the City of York Council. In those circumstances please call the City of York Council on 01904 554444

Person making enquiry *

Parent/Carer (please complete part 2)
Professional (please complete part 1 before proceeding to part 2)

Part 1. Referrers Details

Name

Organisation

Role

Telephone

Email Address

Involvement with family

Preferred method of contact

Telephone
Email

Part 2. Family Details

Parent/Carer Name *

Current address

Address line 1 *

Address line 2 *

Town *

Region *

Postcode *

Country *

Telephone *

Email Address

Relationship to child *

Preferred method of contact

Telephone
Email

Families
- York's Local Offer
  - Parent and Carer Support
    - Short Breaks
      - Short Breaks Enquiry

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Short Breaks Enquiry

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