Family group CONFERENCEs Referral Form RefERRAL CRITERIA: Type Description Please tick Children In Need Child Protection Public Law Outline Where the Public Law Outline is being considered or in process Early Help Children, young people and families not subject to or to prevent the escalation to statutory Services Looked After Child RefeRreR: Local Direct Line Working Email Referrer’s Name Authority days/ hours &Team RefeRred Child/ren: Name Date of Birth Age Parents: Name Address including Phone Parental Postcode numbers Responsibility? Yes No Yes No OTHER EXTENDED INDIVIDUALS: Name Address Phone Does the family require an interpreter? Yes No Does the child/ren have an advocate in place? Yes No Is it likely that the child/ren will need an advocate? Yes No Are there any special needs within the family/child? e.g. disability. Please Yes No outline: KEY AGENCIES involved: Name Agency Telephone Reason for meeting: (Please include a brief description of the current situation and if known the proposed questions to be addressed) Family view of referral:
Family group CONFERENCEs Referral Form RefERRAL CRITERIA: Type Description Please tick Children In Need Child Protection Public Law Outline Where the Public Law Outline is being considered or in process Early Help Children, young people and families not subject to or to prevent the escalation to statutory Services Looked After Child RefeRreR: Referrer’s Name Local Authority &Team Direct Line Working days/ hours Email RefeRred Child/ren: Name Date of Birth Age Parents: Name Address including Postcode Phone numbers Parental Responsibility? Yes No Yes No OTHER EXTENDED INDIVIDUALS: Name Address Phone Does the family require an interpreter? Yes No Does the child/ren have an advocate in place? Yes No Is it likely that the child/ren will need an advocate? Yes No Are there any special needs within the family/child? e.g. disability. Please outline: Yes No KEY AGENCIES involved: Name Agency Telephone Reason for meeting: (Please include a brief description of the current situation and if known the proposed questions to be addressed) Family view of referral:
FGC%20Referral%20form.docx