Lamplight API response

First name

Last name

Address 1

Address 2

Address 3

Address 4

Address 5

Postcode

Email address

Mobile phone

We would like to contact you regarding your participation to the Happy Group project. Please tell us how we can contact you:

By post

By email

By mobile

By text message

Other information

Date of birth

If age is disputed please give claimed age AND age given by Home Office/Local Authority

Country of origin

Ethnicity

Ethnicity other (please give details)

Languages spoken

Would you like an interpreter in this language?

Immigration status

Housing status

When did they arrive in the UK? Please give an estimate date if unsure

Physical and/or Mental Health Condition

Physical and/or Mental Health Condition Details

Is there anything else you’d like us to know?

Main Emergency contact

Name

Contact Number of the Emergency Contact

Relationship to the young person

If Other, please specify

Parent/Carer/Support Worker details (if under 18)

Parent/Carer/Support Worker Full Name

Parent/Carer/Support Worker phone number

Parent/Carer/Support Worker email

Social worker (if applicable)

Social worker full name

Social worker email

Social worker phone number

Social worker place of work

Referral details

Is this a self referral?

If it is not a self referral, add the name of the referrer below

Referrer email

Referrer phone number

Referrer job title

Referrer place of work