Report a serious concern about a child (MARF)

Discussion with parent(s) or carer(s)

Are the parent(s) or carer(s) aware that you are making this referral and that this information may be shared with third party agencies?

Yes

No

Explain why

It is good practice to tell parents/carers that information from this referral may be shared with other third parties, such as police or health services unless doing so will put a child at risk.

Details of child(ren)

Are your concerns about a child that's yet to be born?

Yes

No

Due date

Do you want to refer another child in the same family setting?

Yes

No

Child 2

First name

Last name

Telephone number (if known)

Gender

Male

Female

Transgender

Other

Describe the child's gender

Date of birth (if known)

Ethnicity

First language (if known)

Unique pupil reference number (if known)

NHS number (if known)

GP practice (if known)

Does the child have any disabilities?

Don't know

No

Yes

Describe the child's disabilities

Do you want to refer another child in the same family setting?

Yes

No

Child 3

First name

Last name

Telephone number (if known)

Gender

Male

Female

Transgender

Other

Describe the child's gender

Date of birth (if known)

Ethnicity

First language (if known)

Unique pupil reference number (if known)

NHS number (if known)

GP practice (if known)

Does the child have any disabilities?

Don't know

No

Yes

Describe the child's disabilities

Do you want to refer another child in the same family setting?

Yes

No

Child 4

First name

Last name

Telephone number (if known)

Gender

Male

Female

Transgender

Other

Describe the child's gender

Date of birth (if known)

Ethnicity (if known)

First language (if known)

Unique pupil reference number (if known)

NHS number (if known)

GP practice (if known)

Does the child have any disabilities?

Don't know

No

Yes

Describe the child's disabilities

Do you want to refer another child in the same family setting?

Yes

No

Child 5

First name

Last name

Telephone number (if known)

Gender

Male

Female

Transgender

Other

Describe the child's gender

Date of birth (if known)

Ethnicity

First language (if known)

Unique pupil reference number (if known)

NHS number (if known)

GP practice (if known)

Does the child have any disabilities?

Don't know

No

Yes

Describe the child's disabilities

Do you want to refer any more children in the same family setting?

No

Yes

Details of the additional child(ren)

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Details of child(ren)

Child 1

Child 2

Child 3

Child 4

Child 5