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Child Contact Centre
SF&MS Referral Form
(Standard for Supervised Contact)

Wherever possible this form needs to be seen and completed (download the PDF version here.) by both parties’ solicitors and any other professionals involved with the family.

Contact cannot commence until this form has been completed in full and received by the Centre Coordinator.

All information will be treated in the strictest confidence.

1. Children

Names(s)
 
Age
 
Date of birth
 
Boy (B)
Girl (G)
Ethnicity
Enter no.

2. Adult requesting contact

 Yes No

3. Adult with whom the child(ren) reside

4. Referrer

5. CAFCASS, Contact Orders & Contact

 Yes No
 Yes No
 Yes No
 Yes No

6. Other Statutory/Voluntary services involved

 Yes No
 Yes No

7. Court Orders/Current Proceedings relating to the family

 Yes No
 Yes No

8. Arrival at the Child Contact Centre

 Yes No
 Yes No
Names(s)
Relationship to child

9. Information Relating to Safety of the Child

 Yes No
 Yes No
 Yes No
 Yes No

10. Health & Medical Requirements

 Yes No
 Yes No

11. Additional Information

 Yes No
 Yes No

12. What do the parties see as their long-term goal for contact?

 

I have explained the rules of the Child Contact Centre to my client and given them a copy of the Centre’s leaflet/guidelines. This form has been completed accurately and to the best of my knowledge.

 

N.B. Only dates and times of families attendance will be disclosed unless it is felt that anyone using the Child Contact Centre or a volunteer / staff member is at risk of harm, save where a report has been commissioned by Cafcass or other statutory agency funding contact.

You can also download the PDF version here.

N.B – Please make sure you have read our cancellation policy.

  • Family disputes that are resolved through mediation are cheaper, quicker and according to academic research, less acrimonious than those that are settled through the courts."

    National Audit Office 2/3/07