Local Authority Referral Form – Family Time Services
  • Local Authority Referral Form – Family Time Services

    Complete this form to refer families for Family Time Services. All information is treated confidentially. All sections must be completed for referral acceptance.
  • Referrer / Allocated Social Worker Details

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  • Date*
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  • Details of Services Required

  • Required Services*
  • When did the child/ren enter placement?*
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  • Booking Requirements – Preferred Session Times

    Our diary is booked on a fortnightly rotation. Sessions can be booked to take place weekly, fortnightly or four-weekly. If you require larger gaps between sessions, such as half terms only, please call us directly to discuss.  If you need a different booking to the times noted please call us to directly to discuss.  School age children will be priority booked for afterschool and weekend slots. If children are not of school age, where practical, please utlilise day time slots.
  • Preferred Week Day Family Time Session Slots
  • Preferred Weekend Family Time Session Slots
  • Details of Children Attending

  • Are the child/ren subject to the following orders:
  • Is an interpreter required?*
  • Can photos be taken?*
  • Can money / gifts be given?*
  • Can parents/carers meet?*
  • Can phone calls / FaceTime occur?*
  • Foster Carer / Lived with Adult Details

  • Does the Foster Carer / Lived with Adult have additional needs?*
  • Does the Foster Carer / Lived with Adult have Parental Responsibility?*
  • Contact Parent / Adult Details

  • Does the Contact Parent / Adult have additional needs?*
  • Does the Contact Parent / Adult have Parental Responsibility?*
  • Other Agreed Attendees

  • Risk Assessment

  • Does the referred person or any other person attending the Centre pose any risk to themselves or others (staff, families, children)?*
  • Have the Police ever been involved with anyone attending the Centre? (Include details of involvement and any convictions, arrests, cautions, custodial sentences)*
  • Are there any potential risks in the interaction between children and others in the contact sessions? (e.g., inappropriate language, negative comments, incitement of negative behaviour)*
  • Are there any specific issues not noted above? (e.g., health concerns)*
  • Rows
  • Payment Details & Terms of Service

    Foundations: Supporting Families will invoice on the last day of each calendar month. In order for this to be a seamless process, we require the following information before we can provide a service. These details should relate to your accounts/procurement department, not the referrer. We should also be in receipt of any documentation that requires us to sign up to any payment and vetting system.
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  • Terms and Conditions of Service

    1. Payment Terms

    1.1 All invoices are payable within 30 days of the invoice date unless otherwise agreed in writing.

    1.2 Failure to make payment within the stated terms shall constitute a material breach of this agreement. FSF reserves the right, without prejudice to any other remedy available, to:

    Suspend services with immediate effect;
    Withhold reports and documentation; and/or
    Recover any outstanding sums through appropriate legal means.
    1.3 FSF reserves the right to charge statutory interest and reasonable recovery costs on overdue invoices in accordance with the Late Payment of Commercial Debts (Interest) Act 1998 (as amended).

     

    2. Cancellation Policy

    2.1 The local authority shall be liable for cancellation fees as follows:

    Less than 72 hours’ notice prior to the scheduled session – 100% of the agreed session fee;
    More than 72 hours’ notice prior to the scheduled session – no charge of the agreed session fee.
    2.2 Notice of cancellation must be provided in writing (including email) and will be deemed effective upon receipt by FSF.

    2.3 Failure to attend a scheduled session without notice will be treated as a cancellation with less than 72 hours’ notice and charged at 100% of the agreed fee.

     

    3. Termination and Notice Period

    3.1 A minimum of 7 days’ written notice is required to terminate or cease future services.

    3.2 The paying party shall remain liable for payment of all sessions scheduled within the 7-day notice period, calculated from the date written notice is received by FSF.

    3.3 Termination shall not affect any accrued rights, remedies, or outstanding payment obligations.

     

    4. Ongoing Bookings and Liability

    4.1 FSF will continue to schedule sessions in accordance with the agreed arrangement unless and until written notice is received confirming cessation of services.

    4.2 The paying party is responsible for ensuring timely notification if services are no longer required. Failure to provide such notice will result in liability for all booked sessions in accordance with this agreement.

     

    5. Right to Withdraw Services

    5.1 FSF reserves the right to withdraw or suspend services at any time where:

    There is non-payment of fees;
    There is a safeguarding concern;
    There is abusive, threatening, or inappropriate behaviour towards staff and/or other service users; or
    Continuing the service is no longer reasonably practicable.
    5.2 Where reasonably possible, FSF will provide written notice of withdrawal of services.

     

    6. Family Time Reports

    6.1 Family Time Reports will be provided to the allocated social worker via secure email within 5 working days of the session taking place, unless exceptional circumstances apply.

    6.2 Reports are prepared for professional use within statutory proceedings and will not be routinely distributed to parents, adults, or carers.

    6.3 Any request for copies of reports must be made via the allocated social worker or the requesting party’s legal representative.

    6.4 FSF accepts no liability for any unauthorised distribution, amendment, or reliance upon reports by third parties.

  • Date*
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  • Should be Empty: