Referral Form


Visits are by referral. Please note that our Child Contact Centre offers supported contact only. Supported contact takes place in a variety of neutral community venues where there are facilities to enable children to develop and maintain positive relationships with the non-resident parents and other family members. Supported Child Contact Centres are suitable for families when no significant risk to the child or those around the child has been identified.

The basic elements of supported contact are;

  • Impartiality
  • Staff and volunteers are available for assistance but there is no close observation, monitoring or evaluation of individual contacts/conversations
  • Several families are usually together in one or a number of rooms
  • Encouragement for families to develop mutual trust and consider more satisfactory family venues
  • Apart from attendance times and dates, no detailed report will be made to a referrer, CAFCASS, a party’s solicitor or Court, unless there is a risk of harm to the child, parent, or Centre worker
  • An acknowledgement that it be viewed as a temporary arrangement to be reviewed after an agreed period of time.

Guidelines for referrals

  • Please do not refer a client without contacting the Child Contact Centre Co-ordinator first to check availability of space and time
  • The Centre Co-ordinator should receive a completed referral form one week in advance of the date, which your client would like contact to commence. Where a Centre has a waiting list, a completed referral form should still be sent, the Centre will then notify you when a place becomes available
  • Only people named on the referral form will be allowed admittance to the Child Contact Centre. This may be varied by written agreement by both parties
  • Parents are responsible for their children at all times whilst they are at the Child Contact Centre
  • Please ensure that both parents have read and understood the Child Contact Centre’s information leaflet in advance of contact starting
  • To try and maintain a friendly, impartial and confidential environment, we would request that you do not at any time ask to see your clients on our premises without prior agreement
  • Only dates and times of a family’s attendance will be disclosed unless it is felt that anyone using the Centre or a volunteer or a member of staff is at risk of harm. In the unlikely event of it becoming necessary to quote a Centre Co-ordinator in any report, due to a centre user, volunteer or a member of staff being at risk of harm, the form of words used should be checked and agreed with that person concerned beforehand
  • Child Contact Centres providing Supported Contact will not knowingly accept a referral when somebody involved has been convicted of any offence relating to physical and/or sexual abuse of a child, unless there are exceptional circumstances and they have sought appropriate professional advice
  • The Child Contact Centre reserves the right to reduce or terminate contact if it is felt to be in the best interest of the child
  • Parents should be informed that because of the welfare of the child is paramount, there might be times when contact cannot take place if the child is too upset even if there is a contact order
  • Referrers should make arrangements for the provision of an interpreter where English is not the first language of the family involved and problems may arise with communication
  • The Centre should be viewed as a temporary facility to establish contact. The Child Contact Centre will be asking for your assistance to review the family’s progress after six months
  • Please notify the Child Contact Centre Co-ordinator if the arrangements for contact are going to change or if contact is going to cease.

Please complete the referral form below

Fields marked with a * are required.

The referrer

The resident parent

The non-resident parent

Is a parental responsibility order in place?*

Name(s) of child(ren)

Is your child a boy or a girl?*

Is a parental responsibility order in place?*

Is your child a boy or a girl?

Is a parental responsibility order in place?

Is your child a boy or a girl?

Is a parental responsibility order in place?

Is your child a boy or a girl?

Is a parental responsibility order in place?

Is there an allocated CAFCASS Officer? (If 'Yes', please give details below)*

Is there a court order relating to contact?*

If yes, please either send a copy or indicate what it specifies

What other court orders have been made in relation to the child(ren) and when?

If there is no contact order, have the parents agreed that the child can be taken out of the centre?*

Are the parents willing to meet?*

Will the adult with whom the child(ren) reside be bringing them to and collecting them from the centre?*

If 'No', who will be bringing?

What is the proposed date of first contact at the centre?*

How frequently will contact take place?*

For how long will each visit last?*

Name(s) of other people allowed to participate in contact at the centre

Are there or have there been sexual / child abuse allegations made in this family?*

If yes, please give details

Is this family known to social services?*

If yes, please give details

Has there been or is there likely to be a risk of abduction?

If yes, please give details

Please give details of any undertakings, injunctions or convictions relating to violence involving either party, their respective families or the children or whether resident parent and children are in hiding.*

Do any parties involved in contact have a criminal record or pending court appearances?*

Do any of the children have specific needs or medical requirements?*

If yes, please give details

Do any of the adults involved suffer from long-term physical / mental illness or a disability?*

If yes, please give details

What language is spoken at home?*

Is an interpreter required?*

Has this family ever used another Child Contact Centre?*

If yes, please give details

Additional background information

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