I the parent/guardian understand the above and agree to the sharing of personal information between agencies as described. I also understand that the information provided will be stored on a Children’s Social Care database and that I may see the records held by Children’s Social Care that directly concern me. I the professional making the contact has explained the above to the parent/guardian who has agreed to the contact but has not been able to sign to that effect. Signed: Print name: Relationship to child: Date: If verbal consent has been given by parent/guardian please document how this contact was made i.e. telephone, face-to-face and when it was given: If consent has not been given, please evidence the indicators of potential needs or risks from harm to the child that, in your professional opinion, demonstrates the threshold for tier 3 or 4 is met and so needs to be considered by Portsmouth MASH: If you have been unable to obtain the parent/guardian's consent to share this concern because you have not been able to make contact with them and you feel further delay would have a negative impact on the child. You must give details of the dates, times and methods by which you have attempted to contact them
I the parent/guardian understand the above and agree to the sharing of personal information between agencies as described. I also understand that the information provided will be stored on a Children’s Social Care database and that I may see the records held by Children’s Social Care that directly concern me. I the professional making the contact has explained the above to the parent/guardian who has agreed to the contact but has not been able to sign to that effect. Signed: Print name: Relationship to child: Date: If verbal consent has been given by parent/guardian please document how this contact was made i.e. telephone, face-to-face and when it was given: If consent has not been given, please evidence the indicators of potential needs or risks from harm to the child that, in your professional opinion, demonstrates the threshold for tier 3 or 4 is met and so needs to be considered by Portsmouth MASH: If you have been unable to obtain the parent/guardian's consent to share this concern because you have not been able to make contact with them and you feel further delay would have a negative impact on the child. You must give details of the dates, times and methods by which you have attempted to contact them
Inter-Agency-Contact-form-Aug-2018.docx