Bereavement support

Referral form for Support following the loss of a loved one to Violence

Use this form to refer a family or parent who may benefit from our support following the death of a loved 25 or under.

A Safe Space

A confidential, non-judgemental environment including a mother's WhatsApp group where bereaved mothers can speak freely and feel truly heard.

Peer Connection

Connect with others who truly understand. Shared experience is one of the most powerful forms of support.

Ongoing Support

Regular group family days out, a WhatsApp support group, and access to CAV's wider bereavement and advocacy services.

Referral Form

This form can be completed by a professional, family member, friend, or the parent themselves. All information is treated with the utmost confidentiality.

About You — Person Making This Referral

Your Full Name *

Your Relationship to the Family *

Your Email Address *

Your Phone Number(optional)

About the Parent / Family Being Referred

Parent / Carer Full Name *

Parent / Carer Phone Number(optional)

Parent / Carer Email Address(optional)

About the Loss

Name of Child / Loved One Lost *

Age at Time of Loss(optional)

Brief Background / Circumstances *

Court & Legal

Has the family already had their trial?

YesNo

Would this family like support from Ty's Legacy to help with the financial burden during the court process?

Support Needs

What support does this family need? *

Consent & GDPR

I confirm that the parent / family member is aware of this referral and has given their consent to be contacted by CAV. *I understand that the information provided will be held securely by CAV and used solely for the purpose of providing support. It will not be shared with third parties without consent. *