CN: 1207646

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Help in one of our teams below.

Pastoral Outreach.
Talking about Jesus Christ’s unconditional love to someone (Street Evangelism).
Online prayers.
Befriending Practice.
Hospital visit.
Residential visit.
Fitness Practice- Walking or Dancing Group.

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Social Inclusion & Support Activity Service’s Referral Form

Charity Reg: 1207646

The AMI-HOR UK Provides Free 8 Weeks Interactive Social Inclusion & Support
Activities that fosters Effective Communication, Collaborative Problem-Solving that
Enhances Holistic Well-Being of the Benefactors.

Please tick as appropriate:

Healthy Relationshiop

Online Bible Study (Adult)

Befriending Services

Adult Choir

Positive Parenting Workshop

Information/Advice

Online Bible Study (Children)

Online Yoruba Bible Study

Children Choir

Who am I?

Self-Worth

Self-Connection

Growing Confidence

Pastoral Support

Prayer Support

Marital Support

Mentoring

Organisation:

Is the parent/carer aware of the referral?

Yes

Re-referral/Previously known?

Yes

Family Details

Parents / Carers First Name

Parents / Carers Last Name

Children / Young person's First Name

Children / Young person's Last Name

Date of birth

Gender

Male

Female

School Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Add more children / young person's namee

Yes

Children / Young person's First Name

Children / Young person's Last Name

Date of birth

Gender

Male

Female

School Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Add more children / young person's nameee

Yes

Children / Young person's First Name

Children / Young person's Last Name

Date of birth

Gender

Male

Female

School Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Add more children / young person's nameeee

Yes

Children / Young person's First Name

Children / Young person's Last Name

Date of birth

Gender

Male

Female

School Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Add more children / young person's nameeeee

Yes

Children / Young person's First Name

Children / Young person's Last Name

Date of birth

Gender

Male

Female

School Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Family Current Address:

Address Line 1

Address Line 2

City

State

Zip Code

Country

School Address:

Address Line 1

Address Line 2

City

State

Zip Code

Country

Telephone

Type of Child/Young Person’s Current Accommodation:

Type of Child/Young Person’s Current Accommodation:

Council

Privately rented

Residential/Foster Home

Housing Association

Owner/Occupier

Bed & Breakfast

Rough Sleepers

Please tick as appropriate

Organisation

Individual

Family

First Name

Last Name

Address

Address Line 1

Address Line 2

City

State

Zip Code

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Referral Date

Reason for referral

Agency/Relationship to Family:

Tel:

Please indicate child’s ethnic group by ticking one box

(White) British

(White) Irish

Other White

(Asian or Asian British) Indian

(Asian or Asian British) Paskistan

(Asian or Asian British) Bangladesh

(Asian or Asian British) Other Asian

(Chinese or other Ethnic Group) Chinese

(Chinese or other Ethnic Group) Other Ethnic Group

(Mixed) White and Black Caribbean

(Mixed) White and Black African

(Mixed) White and Asian

(Mixed) Other Mixed

Achievers Ministries International-Habitation of Refuge UK (AMI-HOR UK) 2023

About Us

AMI-HOR UK CHARITY IS A VIBRANT COMMUNITY ORGANISATION PREPARING THE WAY AND REMOVING OBSTACLES TO EMBRACING RIGHTEOUSNESS AND ENJOYING PEACE, JOY, AND PROGRESS (ISAIAH 57:14).

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