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Mentor/Independent Visitors Name
Childs initials
Date
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Brief description of activity / visit
Any safeguarding concerns or significant information
Any health and safety issues?
Mentoring – key goals and progress made towards goals
Mentoring & IV - outcomes achieved eg social skills, emotional wellbeing, life skills, raising aspirations
Expenses
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Activity Cost - £
Milage/Travel Claim
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Travel to (postcode)
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Travel method
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