Adults / Parents Reporting a Safeguarding Concern

Please use this form to report non-urgent safeguarding concerns. If you believe that a child is in immediate danger, please call the police immediately by calling 999. If it is non-urgent, complete and submit the form below which will be sent to our Senior Designated Lead, Mrs Catherine Arrowsmith. Please provide us with as much information as you can, so that we have a full understanding of the child’s circumstances and so that we can respond promptly.

Name of the person reporting the concern

First Last

Address

Street Address Address Line 2 City County Postcode Country

Are the child's parent(s)/carer(s) aware that you are reporting your concern?

Yes

Has the child's parent(s)/cerer(s) consent been obtained?

Yes

Has consent been given for information sharing?

Yes

If not, please explain why:

Name of child:

First Last

Nature of concern:

Please explain the concern you have about the child/ren. Please explain the arrangements to keep the child/ren safe? Where is/are the child/ren at present?

Signed

Date