Adoption Team Referral Form

ADOPTION TEAM REFERRAL FORM

FOR SPECIAL GUARDIANSHIP SUPPORT PACKAGE

Child’s name / Date of birth / ICS No.
Pros SG name, DOB, address, contact number, relationship to the child and details of all persons living in the house hold.
Birth Family composition including any maternal or paternal siblings
Passport
SG often like to take children aboard to visit relatives or go on holiday, so it is important that every child has a passport. It is also required as ID.
Does the child/ren have a British passport?
Yes
No
If yes where is it?
If no, do we have the child/ren’soriginal birth certificate in the safe if not you will need to obtain one. If child’s mother is not British you will need to get mother’s passport details. If mother does not have one, can you ask for her for an original copy of her birth certificate and immigration documents (if applicable) and put in the LA safe.
Please make sure you record a case note on ICS stating where documents are held..
Brief summary of case history (no more than 2 paragraphs) including reasons for removal
Child’s educational development/needs
Child’s Emotional and behavioural development/needs
Child’s interests
Does the child have any disability?
Child’s health development and needs
What financial support has been provided, and have plans been made for any financial support in the future?
Dynamics in relationships
Are parents in relationship?
Does the child know prospective special guardians and if so describe their relationship?
What is the relationship like between the parents and prospective special guardians and is there likely to be any difficulties once the SGO is made
How will the SGO impact on the special guardians children/grandchildren?
Contact arrangements
Name & relationship / Current contact schedule, frequency, duration, venue & supervisor. Please include any plans for letterbox, telephone, skype contact / Plans for post-SGO contact schedule, venue & supervisor
Parents
Grandparents
Siblings including half sibling
Have the contact plans been discussed with the applicant? Yes
Legal status / Date SG Support package has to be filed / Date SGO assessment has to be filed / Date of Final Hearing
Name of court & case number / Names of parties
Other contacts details / Name of SW/ISW completing the SGO report (reg. 21) / Name of Solicitor
Name of social worker making referral / Date of referral
PLEASE NOTE REFERRAL WILL NOT BE ACCEPTED WITHOUT A COPY OF THE VIABILITY OR CONNECTED PERSONS ASSESSSMENT / Date of assessment

NB: This form needs to be completed in order for the Adoption Team to assess the applicants for a support package. The details requested do not have to be extensive – a short paragraph will do for each section.