Kinship Connected: local authority referral form

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Questions marked with a red asterisk (*) are mandatory.

Name of local authority:

Name of programme:

All one-to-one support referrals for this area have been received at this time. However, you can still refer carers for Kinship Membership Advice support using this form. If you require further information, please get in touch with your Kinship contact or email kinshipconnected@kinship.org.uk.

Commissioning of this programme has come to an end. We are currently awaiting a decision on whether this service will be recommissioned. We are unable to receive new referrals until then.

If you require further information, please get in touch with your Kinship contact or email kinshipconnected@kinship.org.uk.

Please note only carers with a Special Guardianship or Child Arrangement Order are eligible for support on our Kinship Connected Programme however they can be supported via Advice for which a case will be created

Kinship Connected is not currently available in this area. However, you can contact our advice service for support here or on 0300 123 7015.

Please use the link above or call us and do not continue with the form.

Consent permissions:

I confirm that the carer being referred to Kinship Connected has given their consent for me to share their contact information with Kinship and consented for a Kinship staff member to contact them directly.

I confirm I have received consent from the carer being referred

Privacy Statement:

Kinship is committed to making only responsible use of your data. By agreeing to our data protection policy you give consent for us to keep you up to date on news, events, campaigns, free training and support services, personalised information and helpful resources by email, text, direct mail and telephone.

For further details you can view our privacy policy at

https://kinship.org.uk/privacy/

Please tick the box here to confirm you agree with our Privacy Statement.

I agree to the Privacy Statement

If you would like to be removed from receiving any more communications, please email info@kinship.org.uk

Please allow 5 working days to update your details.

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Referrer's details:

Name of team/service making the referral:

Your first name:

Your last name:

Job title:

Organisation or local authority you work for:

Your email:

Contact number:

I am a Kinship project worker filling this in for an LA:

Family information

Kinship carer information:

First name:

This should be their given name as it would appear on official documents.

Known as:

If the kinship carer has a preferred name, please add it here. For example, if their first name is "Samantha" but they are known as "Sam".

Last name:

Date of birth (in this format - 19/02/1965):

Home phone:

Mobile phone:

Address:

Postcode:

Country:

Kinship carer's email:

How many children raised in kinship care are in the household?

Who else lives with the carer? Please note any birth children, partner, other family members:

How long have children been in their care (in years)?

What is the legal order or type of kinship care arrangement predominantly identified by the kinship carer?

Kinship child(ren) information:

Repeat this section for each kinship child in the household by clicking "Add another child".

First name:

Last name:

Date of birth (in this format - 19/02/1952):

How long have they been in kinship care?

What legal order/type of kinship care arrangement is in place?

Support around the family:

Are there any known safeguarding concerns for anyone in the household?

Please state the concerns that are known and who is at risk:

Are there any other services working with the family, including Children's Services?

Safeguarding and support around the family

Contact ID

Are there any safeguarding concerns to report?

Date of incident or disclosure (please input in DD/MM/YYYY format):

Type of risk:

Origin of information:

Other details of origin:

Please give the name of the volunteer or social worker who reported:

Please enter the name of the project worker who reported:

Details of risk:

Please provide details of the risk or concern

Are any external services aware of the risk?

Please tick all of the external services that are aware:

Social Care

Children's Social Care

Police

NSPCC

Other

You have indicated that children's social care are involved. Please give further information on this below:

What other agencies are involved?

Is this risk an active current risk or a historical risk?

By current we mean an active ongoing risk where individual(s) are currently subject to risk. Historic refers to historic risks that are no longer an active threat (e.g. the perpetrator of the risk is incarcerated).

What is the priority level of this concern?

Reason for referral:

Please tell us the primary reason for the referral:

If "other", please specify:

Professionals Network:

I would like to join Kinship’s Professionals Network. (If you tick yes, you'll receive emails about events, best practice, new reports, and other relevant information about special guardians and other kinship carers.)

Contact Information