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Child Safety Referral

Welcome to the Foley Family Contact Centre Child Safety Referral.

Please complete the referral form below to request supervised contact, transport services or other approved services.

To assist us in assessing your referral, please provide all relevant information currently available, including any applicable Court Orders, Risk Assessments and Case Plans.

If supporting documentation is not yet available, you may still submit the referral and provide the documents at a later stage.

Child Safety Referral 

Foley Family Contact Centre accepts referrals from the Queensland Department of Child Safety, Seniors and Disability Services.

Please complete the referral form below and attach any relevant documentation. Submission of this referral does not constitute acceptance of the referral or confirmation of services. A member of our team will review the referral and contact you as soon as practicable.

Child Safety Referral Form

Please complete this referral form and upload any relevant supporting documentation. Submission of this referral does not constitute acceptance of services. A member of Foley Family Contact Centre will review the referral and contact the referring Child Safety Officer and parents.

Child Safety Officer Details

Please provide the details of the referring Child Safety Officer.

Child Details

Please provide the details of the child or children being referred.

Date of Birth
Day
Month
Year

Please include the names and dates of birth of any additional children included in this referral.

Parent Details

Please provide details of the child's parents or relevant family members.

Date of Birth
Day
Month
Year

Parent 2 (if applicable)

Date Of Birth
Day
Month
Year

Current Court Orders

Upload current Court Orders or Child Protection Orders where available.

Are there current Court Orders or Child Protection Orders?

Child Safety Concerns

Risk Assessment

Case Plan

Is a current Case Plan available?

Medical Information

please list allergies if known such as asthma, allergies, diabetes etc.

please provide any relevant medical plans for the children(ren).

Supervised Contact Requirements

Which services are being requested?
please tick which services you require.

if unsure at this time please leave blank.

weekly/ fortnightly/ once off

please enter how long is required for the session eg: 1 hour / 2 hours / 4 hours / full day.

Transport Requirements


Daycare/school, placement address etc


Specific Restrictions

Declaration

Privacy Notice

The information collected through this referral form is used solely for the assessment and delivery of services by Foley Family Contact Centre. Information will be managed in accordance with applicable privacy legislation and will only be used or disclosed where authorised or required by law.

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