Fostering

Notification of a Private Fostering Arrangement

This form should be completed by anyone wishing to notify Barking and Dagenham Council of a Private Fostering Arrangement. The form may be completed by:

The parent or guardian, or person with parental responsibility of the child to be, or being privately fostered
The person with whom the child is, or will be privately fostered
Any other person involved in arranging or notifying the arrangement

Alternatively the information may be contained in the referral form taken by the Referral Officer at the point of initial contact with the local authority.

Please make sure you fill in the fields marked with *

Details of the child or young person

Name (including previous surnames):

Date of birth:

Sex:

Place of birth:

Ethnic origin:

First language:

Religion:

Current address:

Telephone:

Is the child subject to any court order?

Yes
No

If yes, please state the order

Name of current carers:

Relationship to the child:

Details of start of the arrangement

Date of child's arrival/intended arrival in the placement:

Date local authority notified:

Intended duration of the placement:

Notification made by (if from another agency include staff name, address and contact number (if the referral is from a private individual include that persons addresses over the past 5 years)):

Details of private foster carer(s)

Name (including previous surnames):

Date of birth:

Sex:

Ethnic Origin:

First Language:

Religion:

Address (include addresses over the past 5 years):

Relationship to the Child:

Please Note: The person who proposes to privately foster will be required to give details of:

Any offence of which he has been convicted
Any prohibition or disqualification imposed under section 68 and 69 of the Children Act 1989
Any such conviction, prohibition or disqualification, imposed on anyone else living in the household
Any order made at any time specified in regulation under section 68 of the Children Act 1989, or with respect to any child who has been in their care
Any rights or powers with respect to a child that have been at any time vested in authority specified in regulations under section 89 or under an enactment specified in those regulations

The carers will be required to complete a Declaration of Suitability to Privately Foster/Permission to Request Information form at the initial visit. If notifying in writing the form can be attached for them to return.

Others living in the household

Name (including previous surnames):

Date of birth:

Relationship to the Child:

Others regularly present in the household

Name (including previous surnames):

Date of birth:

Address:

Relationship to Foster Carer(s):

Details of child's parents/Those with parental responsibility/Person from whom the child was received

Mother's Name (including previous surnames):

Date of birth:

Ethnic Origin:

First Language:

Religion:

Address:

Father's Name (including previous surnames):

Date of birth:

Ethnic Origin:

First Language:

Religion:

Address:

Other's Name (including previous surnames):

Date of birth:

Ethnic Origin:

First Language:

Religion:

Address:

Relationship to the young person:

Details of the child's siblings

Name:

Date of birth:

Address:

Person with parental responsibility:

If under 16 and not living at home please indicate the care arrangements:

Detail of any other person(s), directly or indirectly, involved in making the arrangement

Name (including previous surnames):

Date of birth:

Address:

Relationship to the young person/carer:

Other information about the child or young person

School:

Address:

GP:

Address:

Other Agency's involved:

Address:

Form completed by

Name:

Designation:

Address:

Telephone number:

I confirm that all the information is correct to the best of my knowledge (Please tick the box to confirm)

Contact

Barking and Dagenham Placement Service

127 Ripple Road

Barking

IG11 7PB

Team Manager: Pranitha Rampersad

Private Fostering Social Worker: Pauline Tsoeu

Team Administrator: Chris Kiddell

Tel: 020 8227 5802 during office hours, 8.30am - 4.30pm.

Tel: 020 8227 5949 outside office hours (answerphone).

Fax: 020 8227 5998

Email: privatefostering@lbbd.gov.uk|

Fostering

Notification of a Private Fostering Arrangement

Please make sure you fill in the fields marked with *

Details of the child or young person

Details of start of the arrangement

Details of private foster carer(s)

Others living in the household

Others regularly present in the household

Details of child's parents/Those with parental responsibility/Person from whom the child was received

Details of the child's siblings

Detail of any other person(s), directly or indirectly, involved in making the arrangement

Other information about the child or young person

Form completed by

Contact