Medway Council Children'S Social Care Referral Form Page 3

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Medway Council Children

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3.

Family details (including all members of the household) (continued)

Name (indicate if

DOB /

Relationship

Address & Telephone

Ethnicity

also being referred)

Age

to the child

4.

Significant others / extended family members / supportive adults

Name

DOB /

Relationship to

Address & Telephone

Age

the child

Medway Council Children’s Social Care Referral Form

3 of 8

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