Children referral form

Your name

Your email

Full address

Names and dates of birth of all children whether living in family home or not and whether children of both parties or either part or adopted

Are you the Applicant or Respondent?
 applicant respondent

Safe telephone number

When would be the best time to contact you?
 morning afternoon evening

If you are the Applicant please state the type of order sought (see below) and provide brief details of why you are seeking the order(s). If you are the Respondent state what order is being sought against you and your grounds for objecting.

Possible Court Orders

the child/children do reside with you

No contact
Defined contact ie when and whether supervised or unsupervised, day or overnight
Indirect contact only ie by phone, text,letters

Prohibited Steps Order
eg not to re-locate child; not to attend child’s school etc

Specific Issue Order
eg where child should be educated, how medically treated, whether child should be allowed to change name; be re-located

Full name, date of birth and address of other parent / party

Have you applied for public funding (legal aid) so that you may be assisted by a solicitor? If so, what is the current status?
 yes no

Have you sought advice from another organisation (e.g. solicitors, law centres, CAB)?
 yes no

If so please state the organisation with approximate dates

Any Particular Degree of Urgency?

Please provide brief details of your financial position