PLACEMENT REQUEST FORM

Please complete the form below which will allow you to make a request to use the contact centre through e-mail.

This form will require a valid e-mail address in order for request to be sent electronically. If you are unable to provide an e-mail address and would still want to make a request for a placement, you can contact the Renfield Child Contact Centre (by post, fax or telephone) by going to the contact us page.

PLEASE NOTE: This form DOES NOT guarantee a place at the contact centre as all places are subject to availability and completion of the referral process.

Your Details

Solicitor Name:
Name of Firm:

E-Mail Address:

Street:
Town:
Postcode:
Are you representing the adult that is requesting contact?

 

Visit Details

Preferential visit time?
Frequency of visits?
Referral Details: Please enter the name of the child(ren) involved in the visit and their date of birth.

 

Other Party's Solicitor Details

Name of Firm:

Street:
Town:
Postcode:

 

TERMS & CONDITIONS OF THE RENFIELD CONTACT CENTRE

Do you accept the terms & conditions of using the Renfield Child Contact Centre?

 

Return to the Solicitor Page