Single Agency Referral Form

Referral into Children's Social Care

This form is to be used when making a referral into Childrens Social Care.

The form should be completed with consent, in line with Working Together unless the referral is due to child protection concerns and to approach the child/young person/parent/carer would mean an increased risk of significant harm, prejudice the prevention or detection of crime, or place an child at risk of significant harm.

For increased security, please only use the buttons provided on the form; refreshing this form or using the browser navigation will result in your data being lost.

To complete this form you must have received consent in line with the working together program unless the referral is due to child protection concerns.
To continue and complete this form please check the declaration box below.

This Field Is Mandatory