Islington Families Professionals Referral Form

Name of Local Authority:

Name of Programme:

Does the carer have a legal order or status for the care of the child they are looking after, or do they have ongoing court proceedings?

Referrers Details

Name of team/service making the referral

Your First Name

Your Last Name

Job Title

Organisation you work for

Contact Number

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

I am a Kinship Project Worker filling this in for another Organisation

Carer's Information

First Name

Last Name

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

Gender:

Other Gender

Marital Status:

Other marital status

Ethnicity

Other Ethnicity

Age Category:

Sexual Orientation:

Other sexuality

Telephone

Mobile

Address Line 1

Country

Postcode

Email (please leave blank if you do not have this information)

Preferred method of contact?

Is the carer caring as part of a couple?

Please add second carer's name

What is the priority need?

Other priority need please specify

What are the current support needs?

How many kinship children are in their care? (If not currently in their care, please state how many children will be in their care)

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

Is there a special guardianship order in place?

Is there current Children's Services involvement?

If yes, please select type of involvement:

If other type of involvement, please specify

Are there any Safeguarding Issues?

If Yes, please provide details

Do project workers need to be aware of anything that may be a risk to their safety when working with the carer? This could include when making a home visit.

If yes, please detail:

Permissions and consent

I confirm that the carer named above has given consent for me to share the above details with Kinship

I confirm I have received consent

I confirm that the carer named above has given consent for Kinship to contact them through the contact methods above

I confirm I have received consent

Data protection

Kinship is committed to making only responsible use of your data. The information you share with will only be used to respond to you directly by our experts. We will not share your data with any 3rd parties. For further details you can view our privacy policy at https://www.kinship.org.uk/privacy-policy

Data protection - please tick the box here to confirm you agree with our privacy policy statement

I Agree

By pressing submit, you are confirming that you have consent to add this kinship carer and for us to contact them.

Contact Information