Child Missing from Education - Referral Form

To be completed for pupils who have gone missing or where a forwarding school or address is not known.

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Email *
School Name
If the pupil has moved into RBWM, please include the most recent known school name *
Name & job role of referrer  *
Referral reason  *
Reason for referral
Please include a detailed explanation as to the reason this referral is being made  *
Actions taken by school/referrer prior to this referral being made  *
Required
Pupil UPN (Unique Pupil Number) *
Pupil Name *
Pupil Address *
Pupil DOB *
MM
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DD
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YYYY
Pupil Year Group *
Pupil Gender  *
Pupil ethnicity *
Pupil Special Education Needs  *
If the pupil has special education needs, please state the pupil's primary need below (if no known SEN, plus put N/A)  *
Is the pupil subject to an early help, child in need, child protection plan or a child in care plan?  *
If the pupil is currently open to early help or social care, please specify the name of the service & the allocated worker
If the pupil is not open to social care/early help please put NO in the box below *
Names of siblings (specify school name if attending a different school)
Parents/Carers names 
Please include all parents/carers names *
Parents/Carers address
Please include all parent/carers addresses below - please specify if residing at a different address to the pupil *
Parents/Carers contact numbers
Please include all contact numbers for all parents/carers and specify which parent/carer number it belongs to  *
Parents/Carers email address
Include all known email addresses for parents/carers - please specify which parent/carer email address it belongs to *
Do both parents/carers you have named above have parental responsibility?  *
Emergency contact name & relationship to pupil 
Please include ALL emergency contact names you have on your system for the pupil 
If you do not have any emergency contacts numbers on record, please state non on record below *
Emergency contact numbers
Please include all contact numbers for the pupils emergency contacts
Name & address of GP for the pupil *
Date of last contact with family *
MM
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DD
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YYYY
Date the pupil last attended school *
MM
/
DD
/
YYYY
Please include here any known additional and relevant information about the child or family so that, if necessary, further enquiries can be made with other local authorities and agencies
A copy of your responses will be emailed to the address you provided.
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