This referral is for local authorities who have funded Kinship Membership.

This includes the following services:

Referred kinship carers will receive a response from one of our advisors within 3 working days.

First Name:

Last name:

Email:

Phone Number:

What is the kinship carer's relationship with the child/children?

Kinship Carers Gender:

Kinship Carers Marital Status:

Kinship Carers Ethnic Group?

Kinship Carers Age Category:

Kinship Carers Sexual Orientation:

What are the support needs of the carer?

Do they have a legal order or status for the care of the child they are looking after, or do they have ongoing court proceedings?

Were Children's Services involved in the placement of the child/ children in this kinship care arrangement?

Are there any Safeguarding Issues?

If yes or not sure, please provide details

Your details as the referrer:

First Name:

Last Name:

Job Title

Email (you'll receive a confirmation email when you submit the form):

Date of referral:

Local Authority