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Please complete the following form to request for help from Time Together at RCJ Advice
We need to record information about you to help with your enquiry. We have a legitimate interest to do this. When we record and use your personal information we: only access it when we have a good reason, only share what is necessary and relevant, don’t sell it to commercial organisations and make sure it is kept safe in our secure case management system.
Please select at least one option to proceed
How did you hear about us?
Please select an option
Self-referred (e.g. through internet search, recommendation by friends & family)
Referred by other legal advice/support organisation
Referred by non-legal organisation (for e.g. mental health support charities, GP's, food banks, community centres)
Referred by Court staff or Judiciary
PLEASE COMPLETE ALL SECTIONS OF THIS FORM AND THE CONSENT FORM
Type of contact service requested & Charges
Time Together Contact Centre offers a maximum of 6 (1hr) supervised contact sessions/maximum of 6 (1hr) supported contact sessions.
Supervised Contact
£50.00
Supported Contact
£25.00
Supervised (Virtual) Contact
£40.00
Handover
£15.00
Who is paying for the contact service?
How frequently will you be using the service?
Weekly
Fortnightly
Monthly
Other
PLEASE NOTE OUR PAYMENT TERMS
Payment must be made 5 working days before the 1st contact session via BACS transfer. (Failure to attend a scheduled contact session without 24 hours prior notice will incur an additional fee being charged) Please note that we do not accept cheques, cash or American Express (AMEX) by way of payment.
About You
Your Name
(Required)
First
Last
Your Home Address
Address Line
City
Postcode
Phone
Email
Relationship to the child
Details about your solicitor
Name of your solicitor
Full Name
Company
Address
Address
City
Post Code
Phone
Email
About your former partner
Name of former partner
First
Last
Former Partners Address
Please select an option
I know the other party address
I don't know the other party's address
Other party Address
Address Line
City
Post Code
Phone
Email
Relationship to child
Details of your former partners solicitor
Name
Full Name (if applicable)
Company
Address
Address
City
Post Code
Telephone
Relationship to child
Young Person/Child(ren's) Details
Please add the details of the young person/child(ren) you are applying for
Name
date of birth
Age
Gender
Who are they living with?
Add
Remove
Who has parental responsibility for the young person/child(ren)?
Length of time since they last met the young person/child(ren)?
This is the adult who is requesting contact
Length of time since they lived with the young person/child(ren)?
CAFCASS, Contact Orders & Contact
Is there an allocated CAFCASS Family Court Advisor?
Yes
No
If yes, please provide details
Family Court Advisor's Name
Full Name (if applicable)
Name of CAFCASS office
Address
Address
City
Post Code
Telephone
When and where did contact last take place?
Is there a court order relating to the contact?
Yes
No
If 'Yes', please send a copy of the order what it directs in the supporting documents section.
What other court orders have been made in relation to the child(ren) and when?
What is the next court date (if any)?
Attending the Child Contact Centre
Are you willing to meet your former partner?
Yes
No
Will the adult with whom the child(ren) resides be bringing them to and collecting them from the centre?
(Required)
Yes
No
If 'No', who will be bringing/collecting the child(ren)?
Information Relating to the Safety of the Child
Are there or have there been sexual/child abuse allegations made in the family?
Yes
No
If 'Yes' please give details
Is this family known to Social Services?
Yes
No
If 'Yes' please give details
Has any person who will be involved in the contact ever been convicted of an offence against a child(ren)?
Yes
No
If 'Yes', please give details below
Has there been or is there likely to be a risk of abduction?
Yes
No
If 'Yes' please give details below
If 'Yes', are procedures put in place for holding passports and other legal documents?
Yes
No
Please give details of any allegations, undertaking, injunctions or convictions relating to violence involving either party, their respective families or the children
Young Person/Children's Risk Assessment
Has the young person/child(ren) displayed any sexualised/challenging behaviour?
Yes
No
If 'Yes', please provide details - this could be current or historical
If 'Yes', how would you like this to be managed by the contact supervisor?
Has the young person/child(ren) shown aggression towards other children or to adults?
Yes
No
If 'Yes', please provide details - this could be current or historical
If 'Yes', how would you like this to be managed by the contact supervisor?
Does the young person/child(ren) have any medical or related condition which may require intervention during contact?
Yes
No
If 'Yes', please provide details - this could be current or historical
If 'Yes', how would you like this to be managed by the contact supervisor?
Does the young person/child(ren) have any disabilities, special needs or medical requirements?
Yes
No
If 'Yes', please provide details - this can be current or historical
If 'Yes', how would you like this to be managed by the contact supervisor?
Does the young person/child(ren) have any known allergies that may require intervention, or avoidance measures to be taken?
Yes
No
If 'Yes', please provide details - this can be current or historical
If 'Yes', how would you like this to be managed by the contact supervisor?
Are there any other risks that may be posed by the young person/chil(ren) that the contact supervisor needs to be aware of?
Yes
No
If 'Yes', please provide details - this could be current or historical
If 'Yes', how would you like this to be managed by the contact supervisor?
Adult's Risk Assessment
Does any adult attending contact have a medical condition which may require assistance during contact?
Yes
No
If 'Yes', please provide details - this could be current or historical
If 'Yes', how would you like this to be managed by the contact supervisor?
Do the adults(s) attending require any special assistance to participate in contact? for example mobility issues
Yes
No
If 'Yes', please provide details - this could be current or historical
If 'Yes', how would you like this to be managed by the contact supervisor?
Does any adult attending contact have issues of alcohol, solvent, or other substance misuse?
Yes
No
If 'Yes', please provide details - this could be current or historical
If 'Yes', how would you like this to be managed by the contact supervisor?
Has any adult attending contact ever displayed sexualised behaviour towards children or adults?
Yes
No
If 'Yes', please provide details - this could be current or historical
If 'Yes', how would you like this to be managed by the contact supervisor?
Has any adult attending contact ever displayed physical abuse or emotional abuse towards children?
Yes
No
If 'Yes', please provide details - this could be current or historical
If 'Yes', how would you like this to be managed by the contact supervisor?
Has any adult attending contact ever displayed physical threats or violence towards a professional?
Yes
No
If 'Yes', please provide details - this could be current or historical
If 'Yes', how would you like this to be managed by the contact supervisor?
Has any adult attending contact ever displayed verbal or racist abuse towards a professional?
Yes
No
If 'Yes', please provide details - this could be current or historical
If 'Yes', how would you like this to be managed by the contact supervisor?
Is any adult attending contact engaging in, or have a history of, criminal activity?
Yes
No
If 'Yes', please provide details - this could be current or historical
If 'Yes', how would you like this to be managed by the contact supervisor?
Are there any other risks that may be posed by the adult attending contact that the contact supervisor needs to be aware of?
Yes
No
If 'Yes', please provide details - this could be current or historical
If 'Yes', how would you like this to be managed by the contact supervisor?
Additional Information
What languages are spoken at home?
Is an interpreter required?
Yes
No
Who is paying for the interpreter?
Has this family ever used another Child Contact Centre?
Yes
No
If 'Yes', please give details (this Centre may be contacted)
Please provide additional background information
Supporting Documents
Upload your documents
Please upload the key court documents relating to your court case. By providing a copy of your documents, we will be able to process your request faster. Key court documents include: Letter Before Action, , Court Order(s), You can also upload any key correspondence with the other party or the court if relevant.
Drop files here or
Select files
Max. file size: 20 MB.
IMPORTANT
Time Together will issue one copy of each report directly to each party by secure email. Requests for duplicates will incur further charges.
Declaration
(Required)
I have received the rules of the Child Contact Centre along with a copy of the Terms and Conditions and agree to be bound by them. This referral form has been completed accurately and to the best of my knowledge.
Signed
Date
DD slash MM slash YYYY
Print Name
(Required)
First
Last
Relationship to child
Monitoring Equalities Data
Gender
Female
Male
Transsexual
Non-binary
Prefer not to say
Other
Age
16-24
25-34
35-44
45-64
65-74
Prefer not to say
What is your ethnicity?
Asian or Asian British
Black, African, Caribbean or Black British
Mixed or Multiple ethnic groups
White
Prefer not to say
Other
Do you consider yourself to have a disability or health condition?
Mental Health
Physical
Cognitive
Sensory
None
Prefer not to say
Other
Consent and Feedback
We need your explicit consent to share your data with our volunteer solicitors
Yes, I consent to share my information and documents with RCJ Advice's volunteer solicitors
Our service is staffed by volunteer solicitors from local firms and we need your consent to share your data with them. If we cannot share your data with our volunteer solicitors, they will not be able to advise you.
We need your explicit consent to record and use your special category of personal data
Yes, I consent to you recording special category data
What is a special category of personal data?
This is information about a person that is sensitive and can put them at risk of discrimination. It includes information about ethnicity, and health conditions.
If you agree, we’ll use this information to give you advice, help us gather information to improve our service and support our research in a way that you can’t be identified.
Can we contact you for feedback?
Yes, I consent to you contacting me for feedback
We want to make sure our service meets your needs. To help us understand how we’re doing and to improve our service, we may want to contact you at a later date to ask for your feedback. We’ll decide who we contact for feedback based on the services you used and the advice area. We may also use your special category of personal data so that we hear from different groups.
Thank you for completing our form
Completing this form does not guarantee that we can offer you an appointment. Your form will be reviewed by the team and we aim to contact you within 5 working days.
