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Contact us
Contact Center Referral.
Step
1
of
8
- Your Details
12%
About the Person Completing this Form
In what capacity are you making this referral?
I am a visiting parent
I am a residing parent
I am a professional acting on behalf of parents
Services required
Please tick all that are appropriate.
Supervised Contact
Virtual Supervised Contact
Supervised Contact
Is there a potential risk of harm? The centre ensures the physical safety and emotional well-being of children in a one-to-one observed setting. This form of contact is provided where it is assessed that there might be a higher risk or greater complexity in a family’s circumstance. These sessions will be supervised by staff who are experienced in this role. Observations will be made, and reports will be written. It is generally expected that staff will remain within sight and sound of children at all times.
Virtual Supervised Contact
Virtual Supervised Contact is a service provided by Trinity support services to enable safe, supervised contact between children and their family members through digital platforms such as video calls and Teams calls. It is used when face-to-face meetings are not possible or appropriate, ensuring that relationships are maintained in a safe and structured way. One of our family practitioners oversees the session, offering support during the interaction (if required) and providing both parents with an observation report afterwards.
Your Name
First
Last
What is your relationship to the Child(ren) / Family Requiring Contact
Telephone Number
Email Address
Home Address
Address Line 1
Address Line 2
City
Post Code
Do you have any Disabilities, Health, or Additional Support Needs?
Yes
No
Please give as much information as possible.
Please give as much information as possible.
Do you have Parental Responsibility for the children in this case?
Yes
No
Parental Responsibility (PR)
Is the legal rights, duties, powers, and responsibilities a parent has in relation to their child. It includes making decisions about the child’s welfare, education, health, and upbringing, and it is automatically held by birth parents, with other individuals able to acquire it through legal means such as adoption, a court order, or being named on the birth certificate.
About the Child(ren) Requiring Contact
Children's Details
Please add a row for each child.
Name
Date of Birth
Gender
Add
Remove
Do any of the children named above have any Allergies, Disabilities, Health, or Additional Support Needs?
Yes
No
Please give as much information as possible.
Previous Contact
When was the last contact with the child(ren)
Please give details as to why the contact ended?
Do the children have any feelings, views, wishes or preferences about contact?
Yes
No
Please give as much information as possible.
Has any work been completed to prepare children for contact sessions?
Yes
No
Please give as much information as possible.
About the Adult Requiring Contact
Please leave any unknown details blank.
Name
First
Last
Telephone Number
Email Address
Home Address
Address Line 1
Address Line 2
City
Post Code
What is the relationship to the Child(ren) Requiring Contact
Does this Person have any Disabilities, Health, or Additional Support Needs?
Yes
No
Please give as much information as possible
Does this person have Parental Responsibility for the children in this case?
Yes
No
Parental Responsibility (PR)
Is the legal rights, duties, powers, and responsibilities a parent has in relation to their child. It includes making decisions about the child’s welfare, education, health, and upbringing, and it is automatically held by birth parents, with other individuals able to acquire it through legal means such as adoption, a court order, or being named on the birth certificate.
How does this adult feel about using the service for contact?
Lived With Adults details
Please leave any unknown details blank.
Name
First
Last
Telephone Number
Email Address
Home Address
Address Line 1
Address Line 2
City
Post Code
What is the relationship to the Child(ren) Requiring Contact
Does this Person have any Disabilities, Health, or Additional Support Needs?.
Yes
No
Please give as much information as possible
Does this person have Parental Responsibility for the children in this case?
Yes
No
Court Proceedings
Has the Court ordered this contact?
Yes
No
In which court was the order made?
When was the order made?
DD slash MM slash YYYY
Please upload a copy of the order if available.
Drop files here or
Select files
Max. file size: 50 MB, Max. files: 5.
Please detail the nature of the order
Are there any Proceedings in the Family Court?
Yes
No
Please give details
Is it possible that any of the parties might initiate new Proceedings in the Family Court?
Yes
No
Please give details or reasoning
Risk Assessment
This risk assessment relates to any allegations made by either party concerning an adult or child. The safety and wellbeing of all adults and children is paramount. We require this information to ensure that appropriate safeguards are in place during visits to the centre or while out in the community. Please ensure that you select a category for each section to allow for a thorough assessment of potential risks.
Risk Assessment
Risk
No Risk
Allegations Only
Physical Abuse
Sexual Abuse
Neglect
Emotional Abuse
Domestic Abuse
Drug Misuse
Alcohol Misuse
Abduction
Conflict
Mental Health
Culture / Religion
Finance
Learning Difficulties
Parenting Capacity
Physical Impairments
Wider Family
Current Crime
Convictions
Pets
Other
Please provide any relevant additional information.
Confirmation
Is an interpreter required for this family?
Yes
No
Languages Spoken / Required
Confirmation of Information and Agreement to Court Orders.
I confirm that the information provided to Trinity Support Services is accurate and up to date. I agree to promptly notify Trinity of any changes to the information discussed and will provide copies of all relevant court orders relating to child contact arrangements. I understand and accept that I am expected to comply fully with the content of any applicable court orders. I acknowledge that failure to do so may result in the withdrawal of this service.
I agree
Payment Agreement
I understand that payment for all agreed sessions must be made in advance of each session. I acknowledge and accept the terms outlined in the Payment Agreement provided by Trinity Support Services.
I agree
Confidentiality Agreement
I agree to maintain confidentiality regarding all matters discussed or observed during sessions, except where disclosure is required by law or safeguarding concerns.
I agree
Health and Safety Compliance
I agree to follow all health and safety procedures, including any COVID-19 or other public health guidelines in place at the time of service
I agree
Contact Centre Rules
1. Punctuality and Attendance
I agree to attend all scheduled sessions at the agreed times. If I am unable to attend or expect to be late, I will inform the family coach in advance, following the agreed communication framework. Cancellations made with less than 24 hours’ notice may result in a cancellation fee. To minimise the risk of conflict or further allegations, I agree to the staggered arrival times. This arrangement is designed to avoid unnecessary contact between adult parties.
2. Drop-Off and Pick-Up Procedure
The adult responsible for dropping off the child(ren) must be present at the door at the start of the session, and likewise, must be at the door at the end of the session. Please do not do anything to disrupt the session as caseworkers are unable to leave the room. Additionally, the adult picking up the child(ren) should not wait in their car for the worker to come out—they must be at the door in person.
3. Substance-Free Commitment
I agree that I will not be under the influence of drugs or alcohol when attending the Centre. If, in the opinion of the Family Coach, any adult appears to be under the influence, the intervention will not proceed.
4. Respectful Conduct Agreement
I agree that I will not behave in a hostile, aggressive, or provocative manner toward anyone while attending planned sessions. Staff are here to support, not to be subjected to abuse—this includes interactions during telephone calls throughout the process.
5. Session Location Agreement
I agree that I will not disrupt the session by removing the child(ren) from the agreed location, unless this has been clearly outlined and approved in the individual work plan.
6. Positive Communication Commitment
I agree to speak positively about my former partner and other family members during sessions, in order to support a constructive and respectful environment for the child(ren).
7. Child Protection from Conflict
I agree to ensure that my child(ren) are not exposed to any disputes or negative conversations concerning their other parent or extended family.
8. Child-Centered Communication
I agree to provide child-friendly responses to any comments made by my child(ren) during sessions. I will avoid making promises—such as suggesting they will be able to come to my home soon—that may create unrealistic expectations. If I am unsure how to respond appropriately, I will consult with the Family Coach before the session begins.
9. Session Management and Parental Responsibility
I agree to allow the Family Coach, at their discretion, to remove my child(ren) from the session if deemed necessary. I understand that it is the visiting parent's responsibility to provide care and support to a child who may become upset during the session. While the Family Coach will offer guidance and support, it remains the parent's role to provide reassurance and appropriate distraction.
10. Photography, Video, and Mobile Phone Use Agreement
I agree that I will not take any photographs or videos unless this has been explicitly agreed upon as part of the individual work plan. Any photographs/videos that are taken must not be uploaded to the internet or shared on any social media platforms. Mobile phones may only be used for the purpose of taking photographs, unless otherwise agreed in the individual work plan.
11. Contact with Extended Family
Requests to Facetime extended family members must be approved by the resident adult, unless explicitly stated in a court order. The same requirement applies to extended family members attending any sessions—they may only do so with prior agreement from the resident adult or as directed by a court order.
12. Gifts and Shared Activities
I understand that the giving of presents and gifts will be limited to celebratory occasions. However, items that support shared activities—such as books or arts and crafts—are acceptable, as they encourage positive interaction during sessions.
13. Snacks, Drinks, and Dietary Considerations
Snacks and drinks should be provided for the child(ren), with clear agreement on who will supply them. The Family Coach must be informed of any allergies, as well as any specific food items that should not be offered.
14. Toileting Support Responsibility
Responsibility for supporting the child(ren)'s toileting needs should be clearly discussed and agreed upon prior to the session. This arrangement will be documented and included as part of the individual work plan to ensure clarity, consistency, and the child(ren)’s comfort during visits.
15. Involvement of Dogs in Sessions
If a dog is brought on site to be involved in sessions with your child(ren), you must ensure the child(ren) understand appropriate behaviour and boundaries around the dog. You are also responsible for cleaning up after your dog. Dogs are only permitted to enter the service once this has been agreed as part of the individual work plan and an appropriate risk assessment has been completed.
16. Session Payment Policy
Payments for sessions must be received no later than 12:00 PM on the day prior to the planned session, unless a prior conversation has taken place and a payment plan has been formally agreed. Sessions may be at risk of cancellation if payment is not received by the stated deadline. When making a payment, the child’s name must be used as the payment reference to ensure accurate allocation.
17. Respect for the Environment
I agree to respect the premises and facilities provided by Trinity Support Services. This includes keeping the environment clean and tidy, using equipment appropriately, and ensuring that no damage is caused. I understand that maintaining a respectful and safe environment is essential for the comfort and wellbeing of all service users and staff. I also agree to leave the room as it was found, ensuring that all items are returned to their original place and the space is left clean and orderly at the end of each session. I acknowledge that if any facilities are damaged or items are broken during my use of the service, I may be held responsible for the cost of repair or replacement. Any such charges will be determined at the discretion of Trinity Support Services.
18. Timely Sharing of Relevant Information
All relevant information—such as court orders, Section 7 reports, or other requested documentation—must be shared promptly as instructed. Timely submission ensures that sessions can be planned and conducted appropriately in line with legal and safeguarding requirements.
19. Session Summaries and Reporting
The Family Coach will complete a summary of the time spent together after each agreed session and will produce a report at the end of each visit. These records will be made available to both parties as soon as possible, provided that payment has been received. It is the responsibility of the adult to share these notes with relevant parties, such as solicitors or other professionals involved in the case.
20. Off-Site Contact Requirement
If the adult with whom the child(ren) lives does not remain on-site during the session, they must be contactable by phone throughout its duration. Please be mindful that we may need to reach you if the child(ren) become upset, unwell, or require your support.
21. Community-Based Activities and Direct Work
As part of your individual work plan, sessions may include time spent in the community, observation of handovers, and direct work with adult parties to support the achievement of the best possible outcomes. All such activities will be agreed upon by all parties involved prior to implementation.
22. Acceptance of Policies and Safeguarding Procedures
I agree to adhere to the policies governing Trinity Support, including the Child Protection Procedure and the Confidentiality Statement. I understand that if a concern arises regarding the abuse or neglect of any child involved in the intervention process, a referral will be made to the appropriate Children’s Services Department. While parents will usually be informed of such referrals, I acknowledge that in certain circumstances, it may not be appropriate to do so.
23. Confirmation of Contact Details
I confirm that the contact details provided to the service are accurate and up to date.
24. Complaints Procedure Acknowledgement
I acknowledge that the provider’s complaints procedure has been shared with me and that I understand how to raise any concerns or complaints should they arise.
25. Fire Evacuation Procedure
- I confirm that the fire evacuation procedure has been discussed with me, and I understand the steps to follow in the event of an emergency.
I have read and agree to abide by all rules set out above.
Termination of Services
I understand that Trinity Support Services reserves the right to terminate services if rules are breached or if the arrangement is no longer deemed safe or appropriate.
I agree
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