Applying for a place

Referrals

To apply for a place with us we must receive a referal. A referral may be made by a third party professional, such as a Solicitor, Mediator, Social Services, or Cafcass, or by the parents themselves (a Self Referral). In normal circumstances a first contact date will be offered between three to four weeks after the referral form is received. Changes to the arrangements for visits may be requested at any time, but no such changes can take place until confirmed by the Centre.

Our Referral Form and Guidelines for Referrers can be requested via email. Please complete the form and send it – together with the £50 fee via bank transfer – to derbychildcontactcentre@gmail.com

A self referral can be made by filling out all sections of the form below. Please ensure you include the contact details for the other parent or a professional who knows these details, such as their solicitor or a social worker. Contact cannot start if we don’t have a means of informing both parties.

In all cases, regardless of who makes the referral, the Contact Centre has the right to decide whether or not to offer a place, and to terminate that place if our rules or Code of Conduct are not followed. The Contact Centre charges a one-off Referral Fee of £50.00 to cover administrative costs, payable via bank transfer (details here). A referral will not be processed, nor any contact arrangements made, until the fee is received.

What happens next?

Once we have recieved your referal form we can allocate a provisional date for contact to start. We will contact you (usually by post) informing you of the provisional date, and with a date to come in for a pre-vist session. The pre-vist session will be a chance for you (and the children) to have a look around while the place is empty, get to know some of our staff and go over our code of conduct and expectations that we and you, may have.

REFERRAL FORM

Name of person making the referral(required)

Email of person making the referral(required)

Phone Number of person making the referral(required)

How did you hear about us? Select one option Please select an option from below: Solicitor / Court process NACCC Press Friend or Family Other Social Media

PARENT DETAILS: Please complete this for applications by individual parents OR legal parties. Name of the adult attending the visit(required)

Address and postcode of adult attending visit(required)

Phone number of adult attending visit(required)

Realationship between child/ren and adult attending visit. e.g parent/child, grandparent/grandchild.(required)

Please list the children who will use the Centre, indicating their sex and including dates of birth, and any illnesses, allergies, or disabilities(required)

Name of adult with whom the child lives(required)

Adress and postcode of adult with whom the child lives(required)

Phone number of adult with whom the child lives(required)

Email address of the adult with whom the child lives

When and why did the relationship between the parents break down?(required)

What is the reationship between the child and the adult the child lives with? e.g parent/child, aunt/nephew with SGO. (required)

When did the child/ren last see the parent they do not live with?(required)

When and where did the last contact take place?(required)

Why any previous contact break down?(required)

Has your family ever been known to or involved with CAFCASS? Is so when?(required)

Has Social Services ever been involved? If so when?

Is there a Court Order? (if yes, we will require a copy of the Order)(required)

Do you have any concerns that you would like to share with us?(required)

Do either parents have any criminal convictions? If yes, please provide details(required)

ARRANGEMENTS FOR CONTACT:Is there an agreement that the child/ren can be taken out of the centre?(required)

Which do you prefer? Saturday (morning or afternoon)Sunday (morning or afternoon) (required)

How long would you like a contact session to last?One hourTwo hoursThree hoursOther (please state)(required)

How often will contact happen?WeeklyFortnightlyMonthlyOther (please state)(required)

What are the names of anyone both parties have agreed can take part in contact? Include anyone the adult attending the visit may bring. (required)

Who will be bringing and collecting the child/ren from the Centre?(required)

Do you believe there is a risk of abduction?(required)

Are the adult attending the visit and the adult brining the the child/ren willing to meet?(required)

Do you need help to understand spoken or written English?(required)

Is there anything else the Centre to be aware of?(required)

Agreement: · I confirm that I have completed this form to the best of my knowledge· I agree to abide by the rules and conditions of the Centre if I am offered a place· I understand that if I have withheld any information or behave in a way that breaks the Centre’s rules or conditions, the Centre may refuse to offer a place or may withdraw the place if they consider it necessary· I am aware the £50 referral fee is required before contact can commence. Please type your full name in the box below. Sending this form automatically enters you into agreement with the above four points.(required)

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Affiliated to and Accredited by the National Association of Child Contact Centres (NACCC)