Kinship Active - Referral Form

Please tick your local authority (this project only runs in the North East at the moment):

Redcar and ClevelandMiddlesbrough

What type of organisation are you (tick one)?

Local authorityNot for profit (charity)Social enterpriseOther

Add other:

Date of referral:

Your details:

First name:

Surname:

Organisation:

Job title:

Phone number:

Email (you will receive a confirmation email):

Contact preferences (Tick one):

AllEmailMobile / Phone number

Kinship carer details:

First name:

Surname:

Mobile number (no spaces):

Email:

Address:

Postcode:

How many kin children in their care?

How long have they been a kinship carer? (Pick one)

What are their support needs in terms of accessing physical activity / health / wellbeing? (Please add as much information as possible).

Are there any safeguarding issues we need to be aware of?

YesNoNot sure

If yes, what are those safeguarding issues (please also indicate if there is anything we might need to be aware of if we do a home visit).

Professionals Network:

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

YesNoHave already joined

Data protecton:

Grandparents Plus 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 third parties.

For further details you can view our privacy policy at https://www.grandparentsplus.org.uk/privacy-policy

Please tick the box here to confirm you agree with our data protection policy.

I agree

By pressing the submit button below, you are confirming that you have permission to add this kinship carer and for us to contact them directly.

Please make sure that you have told them you are making this referral.

Contact Information