Make a Referral

Parent's Details
First Name: A value is required.
Surname: A value is required.
Flat No./House No.:
Street Name:
Postcode: A value is required.
Date of Referral:
Date of Birth:
Telephone No.:
Mobile No.:
Family Status:
SW Invovlement: Current  Previous  None
Children's Details

Please enter details for at least one child

First Name Surname D.O.B Sex Respite
School/Nursery Ethnicity Legal Status Disability
Referrer's Details
Referral Type: Other Agency  Self-referral  Re-Referral
First Name: A value is required.
Surname: A value is required.
Flat No.:
Building No.:
Post Code:
Email Address:
Telephone No.:
Has the family been informed of referral?       Please make a selection.
Referral Criteria
Please check at least one
Live within the East End:
Children Under 16 years:
No other family support:
Mental health issues:
Addiction issues:
Medical condition:
Disability issues:
Vulnerable young parent:
Behaviour/Relationship issues:
Kinship carer:
Reason for referral (and other other information we may need):
A value is required.
Services Required
Please note more than one service can be referred
Family Support:
Respite Sitter:
Respite Care:
Geeza Chance (Activity Based Respite):
TOFFEE Club/Centre Based Respite:
Kinship Family Support:
Groupwork (Please select one)
Life Skills:
Positive Play:
Get Shopping/Get Cooking:
Teen Triple 'P':
Baby Massage:

If One-To-One Triple 'P' is required, select Family Support.

Please check box to agree

* These fields must be filled in

Below Legal Statues for the Family is explained further

  • Section 22 - Provides for the promotion of welfare of children in need
  • Section 25 - Voluntary admissions to care
  • Section 29 - Throughcare
  • Section 45(4) & (5) - Warrant to apprehend
  • Section 52(2) - Grounds of referral for chaildren's hearing
  • Section 55 - Application to sheriff for a Child Assessment Order
  • Section 56(2) C (s) 95 - Initial investigation by the Principal Reporter
  • Section 57(1) & (2) - Application to sheriff for a Child Protection Order
  • Section 59(4) - Continuation of CPO at the second working day hearing
  • Section 61 - Allows for the police to remove a child to a place of safety
  • Section 66 - When a child has come to a hearing but a final decision cannot be made
  • Section 67 - Situation where a child has been kept on a warrant under Section 66
  • Section 68 - Application to the Sherfiff to establish grounds of referral
  • Section 70(1) - Home supervision requirement
  • Section 70(3) - Supervision requirement with a condition of residence
  • Section 70(9) - Supervision requirement with a condition to reside in secure accommodation
  • Section 76 - Exclusion order
  • Section 86 - Perental responsibilities order