Referral and Initial Information Record

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Address Picker


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Referrer/Referral






Select a Wigan Address





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Availability







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CAF



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0 of 1625 characters



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Child/Young person's name and address





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Select a Wigan Address



Select a Wigan Address



Child/Young person's ethnicity, nationality, religion and communication needs

Ethnicity *

White

Mixed

Asian or Asian British

Black or African or Caribbean or Black British

Other ethnic group





Religion *


Disability





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Communication



Child/Young person's principal carer(s) *

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Other household members (including non-family members)

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Significant others who are not members of a child's household

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Enter significant other who is not a member of the child's household




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Key Agencies

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Reasons for referral/request for children's social care services

Please use the following headings to structure your referral and identify how a referral to Children's social care will address the issues you have highlighted and lead to an improvement in the situation.



0 of 1625 characters



0 of 1625 characters



0 of 1625 characters



0 of 1625 characters




0 of 500 characters




0 of 500 characters

*Please note: the information provided on this form cannot be modified once submitted. There will be an opportunity to print the form once it has been submitted.

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