Template 7 Child Protection Incident/Concern Referral Form

Template 7 Child Protection Incident/Concern Referral Form

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Badminton Club or County:
Your name:
Your position/role:
Your contact telephone number(s)
Your email address
Child’s name:
Child’s address:
Child’s date of birth:
Child’s disability (if any):
Child’s ethnic origin:
White / British /  / Irish /  / White - other / 
Mixed / White & Black Caribbean /  / White and Black African /  / White & Asian / 
Asian/Asian British / Indian /  / Pakistani /  / Bangladeshi / 
Black/Black British / Caribbean /  / African /  / Other / 
Chinese / 
Other / 

Parents / Guardians names, addresses & contact numbers:

Date and time of incident/concern:

Your observations (if concerns have been communicated to you record what was said and give the name, role & contact details of the individual(s) who have communicated the information. All concerns should be recorded and referred to the Badminton England Lead Child Protection Officer even if anonymously referred, overheard etc)):

Exactly what the child said and what you (or the individuals involved if not you) said. Remember; do not lead the child – record actual details. Continue on separate sheet if necessary):

Action taken so far:

Who have you informed (please include names and contact details e.g. phone and email if known):

Date / Name / Position / Contact Details

Other information (e.g.: child’s demeanour, any previous concerns relating to individual(s) involved or allegedly involved in incident or cause for concern, names & contact details of witnesses etc)

Signature / Time/Date

PLEASE CONTINUE ON A SEPARATE SHEET IF NECESSARY

Completed forms should be sent to the club or county child welfare officer and also to

BADMINTON England Lead Child Protection Officer, BADMINTON England, National Badminton Centre, Milton Keynes, MK8 9LA

or emailed to