• Please provide the details of the main parent or carer for this referral below. This will be the main family member that we will be working and communicating with. Please note that if the details requested are not entered in full, we will be unable to process the referral.
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  • Please complete the following section to help us assess the family’s needs so that we can offer the most appropriate support and match the most suitable volunteer.Note: Families will not be prioritised based on how many categories are ticked. This information, together with information provided by the family, will help us provide the appropriate support and monitor how our support meets the family’s needs.
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  • Use the section below to enter the details of other adults and the children in the family
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    Add another family member
  • Details of person making referral
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  • Other agencies
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  • By submitting this form, you are confirming that:

    - the information provided is correct to the best of your knowledge
    - the referral has been discussed with the family, who have agreed to a referral being made to Home-Start Westminster.
    - you as the referrer and the family, agree for your details to be stored in our database in accordance with data protection legislation (see our Privacy Notice).

    You understand that we can only accept referrals which have been discussed with and agreed by the family. The information provided in this referral will be held in confidence but may be shown to the family if requested. Where a family has agreed to our support, we will ask them to sign our privacy notice.

    You can find our Privacy Notice here for reference.