Referrals

Recapture Life welcome people from all faiths and ethnicity, no matter their gender or age. If you or a loved one would like to join, please see below.  

CST and vCST Referral Form

The criteria are set out as follows: 


1. The person wants to attend and wishes to remain at the workshop for the duration of the session. 

It must be ultimately the person’s choice to attend. It is not unusual for people living with dementia to be referred to us by members of their family or friends and whilst we encourage this, we must be aware that if the person expresses that they do not want to attend or that they want to leave then their wishes are always respected. 


2. The person has mild to moderate dementia or short-term memory difficulties. 

The workshops are designed for people living with mild to moderate dementia. 


3. The person can focus on group work for a minimum of one hour. 

Group members will need to be happy sitting and engaging in a discussion group. If a beneficiary prefers to walk than sit or is often looking for or asking for someone outside of the workshop more often than not, they would not meet the criteria. 


4. The person is independent with personal care needs.

Whilst this is not a direct issue during virtual workshops, our experience has shown that the correlation between loss of independence with planning, sequencing and executive function correlates with a decrease in engagement and effectiveness of the workshops. 


5. Age.  

There is no minimum or maximum age limit. 

Please download and complete the above forms to attach to your application, using the contact form below. 

Or complete the forms online here:

Referral Form

 Person with dementia wishing to be referred 

Carer/Next of Kin name:

Registration and Agreement Form

Club Member Details:

Contact Details:

Daytime Emergency Contact Details:

1st Contact 

2nd Contact (Required)

Club Criteria:

Consent

Please sign each box that you are willing to give consent for:


The following definitions are used in this document:


Agreement: The agreement between Recapture Life And the Client set out in the signed agreement, the scale of the charges and these terms and conditions as varied from time to time in accordance with those terms and conditions.

Assignment means the engagement, employment or use of the Worker or any third party on a temporary or permanent basis, whether under a contract of service or for services; under an agency, licence, franchise or partnership agreement, or any other engagement, directly through a limited company of which the worker is an officer or employee.

Client means the person; firm or corporate body together with any subsidiary or associated Company as defined by the Companies Act 1985 to which the Applicant is introduced.

Agency means Recapture Life CIC

Recapture Life 

Worker means the Day Club facilitator providing a service for Recapture Life


2.   Member requirements and criteria for attendance to Activity Club

2.1 All club members must be able to take part in activities provided by the facilitator. 

2.2 All members must have the ability to totally self-care with their toileting needs; Facilitators may guide towards the toilet but cannot assist.

2.3 If the client becomes unsettled, agitated or wishes to leave, one attempt at guiding back to the activity will be made. If the client becomes agitated a second time. The carer will be called to collect the member. This will enable the Facilitator to ensure the safety of all clients and the ability to safely provide activity and occupation for all members. The Facilitator has the discretion to call a carer at any point if the member is unable to meet the criteria set out above.

2.4 Any illness or emotional issues must be discussed with the Facilitator prior to the start of the club day. The Facilitator will decide if it is appropriate for the beneficiary to stay for the day at the club.

2.5 Please inform us on 07821 666480 4 if you will not be attending. 

3. Disclosure and Barring Service

3.1 All Workers employed by Recapture Life will hold a clear DBS check.


4. Confidentiality

4.1 All information held by memory Matters SW CIC adheres to Data Protection policies. Available on request


5. Standard of Care and Liability

5.1 No liability by Recapture Life will be accepted for any loss, expenses, damage or delay arising from any failure to provide a session.

5.2 In the event that a client is not satisfied with the standard of the service provided the client shall notify Recapture Life immediately in accordance with Recapture Life Complaints Procedure, which shall be available upon request.

5.3 All staff will risk-assess all activity to ensure the safety of all. Any injury, loss or accident whilst interacting with animals, during an activity session will be at the clients own risk and Recapture Life will not be liable.

5.4 No personal care or manual handling will be undertaken by Activity Workers.

5.5 Any change in circumstances or deterioration of health or condition must be discussed with the Activity Worker to ensure the standard of Activity is appropriate.


7. Insurance

Recapture Life CIC has the following insurance in place:

i) Employers Liability Insurance (at least 5 million in respect of any one claim)

ii)Public Liability Insurance (at least 2 million respect of any one claim)


8. Data Protection 

We take protecting your personal information seriously. Recapture Life will use your data in accordance with our privacy statement. 

Please email Lesley@RecaptureLife.co.uk for further details. 


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