KENT COUNTY COUNCIL SAFEGUARDING UNIT CHILDREN’S LADO REFERRAL FORM for Parents/Carers – Date referred to LADO Section A only complete form if you can answer – ‘Yes’ to Q1 and at least one of the other 3 questions Does this person work in the children’s workforce in Kent [not Bromley, Bexleyheath or Medway (Strood, Rochester, Chatham, Gillingham & Rainham)] Has this person: Behaved in a way that has harmed your child or may have harmed your child? Possibly committed an offence against or related to your child Behaved towards your child or children in a way that indicates that he or she would pose a risk of harm to children if they work regularly or closely with them? Section B Information about you – Your name Address Telephone Number Email address: Section C Information about your Child – Full name Date of Birth Gender Ethnicity Disability (if applicable) Home Address Is your child known to Children Social Care? If yes, please provide details Section C Information about the Person you are referring – (if more than one person involved, please complete separate forms) Full name Date of Birth (if known) Gender Ethnicity Disability (if applicable) Home Address (if known) Where does he/she work? Employer’s name and address (including Agency & Voluntary organisations) Job Title /Role Does the person have any other contact (through work/volunteering with children. Please provide details if known) Section D - DETAILS OF THE REFERRAL What is the nature of the Has your Is this a allegation, concern or harm been harmed historical allegation?
KENT COUNTY COUNCIL SAFEGUARDING UNIT CHILDREN’S LADO REFERRAL FORM – for Parents/Carers Date referred to LADO Section A – only complete form if you can answer ‘Yes’ to Q1 and at least one of the other 3 questions Does this person work in the children’s workforce in Kent [not Bromley, Bexleyheath or Medway (Strood, Rochester, Chatham, Gillingham & Rainham)] Has this person: Behaved in a way that has harmed your child or may have harmed your child? Possibly committed an offence against or related to your child Behaved towards your child or children in a way that indicates that he or she would pose a risk of harm to children if they work regularly or closely with them? Section B – Information about you Your name Address Telephone Number Email address: Section C – Information about your Child Full name Date of Birth Gender Ethnicity Disability (if applicable) Home Address Is your child known to Children Social Care? If yes, please provide details Section C – Information about the Person you are referring (if more than one person involved, please complete separate forms) Full name Date of Birth (if known) Gender Ethnicity Disability (if applicable) Home Address (if known) Where does he/she work? Employer’s name and address (including Agency & Voluntary organisations) Job Title /Role Does the person have any other contact (through work/volunteering with children. Please provide details if known) Section D - DETAILS OF THE REFERRAL What is the nature of the allegation, concern or harm Has your been harmed Is this a historical allegation?
Parents-and-Carers-Kent-LADO-Referral-form.docx