One Adoption Referral Form

Only complete the below referral form if you are a social worker or professional working in One Adoption North & Humber, One Adoption West Yorkshire or One Adoption South Yorkshire and have obtained consent from the data subject/s you are referring.

If you have any questions prior to completing the form, please contact PAC-UK's Advice Line on 0300 1800 090 or email oneadoption@pac-uk.org

PAC-UK is the lead provider in a service (funded by One Adoption) working with 15 Local Authorities to provide support to anyone in the region affected by adoption.

Please include as much detail as possible on the referral form below. Fields highlighted with a red * symbol are mandatory and must be completed in order for you to submit the form.

Please only submit forms once you have obtained consent from the data subject/s you are referring. 

Once you have pressed submit, your form will automatically be sent to the PAC-UK Advice Line who will respond at the earliest possible opportunity. A notification message will appear on your screen confirming your referral has been received and you will receive a copy of your form via email.

All information processed in relation to your enquiry and/or booking adheres to PAC-UK's Privacy Statement.

Note, failure to provide enough information could result in delays. Please read each question carefully to ensure all contact details provided are correct.

One Adoption Referral Form
Referring Local Authority /Agency
If your referring local authority is not listed in the below dropdown menu please contact the PAC-UK Advice Line by phone on 0300 1800 090 or email referrals@pac-uk.org prior to completing this referral form. If you are making a One Adoption referral please visit www.pac-uk.org/oneadoption to be redirected to the correct referral form.
Referring Social Worker /Professional

Name of referring Social Worker /Professional
Name of referring Social Worker /Professional
First
Last
Would you like us to add your email address to our PAC-UK Training and Newsletter mailing list?
All our PAC-UK mailouts include 'unsubscribe' options.
Office address of referring Social Worker /Professional
Office address of referring Social Worker /Professional
Address Line 1
Address Line 2
Address Line 3
City
Postcode
Details of person being referred
Can the person being referred be contacted directly by PAC-UK?
Is the person being referred a birth parent who has had a child adopted within the past three years?
One Adoption ask PAC-UK to report on this information - please complete accurately. Note for PAC-UK staff processing this referral, ‘Date of Adoption’ must be entered on the Client Connection screen after adding ‘Adopted Child’ as a ‘Service User Contact.’
Name of person being referred
Name of person being referred
First
Last
Address of person being referred
Address of person being referred
Address Line 1
Address Line 2
Address Line 3
City
Postcode
This should include anyone listed in 'other household members' and 'details of children' sections of this form.
Name/s of other household members
Name/s of other household members
Name/s of other household members
First
Last
Details of child/ren
Full Name (Child 1)
Full Name (Child 1)
First
Last
Full Name (Child 2)
Full Name (Child 2)
First
Last
Full Name (Child 3)
Full Name (Child 3)
First
Last
Please add any other relevant supporting information here, including any additional children.
Adoption details of person receiving service (if applicable)
Birth Name
Birth Name
First
Last
Adopted Name
Adopted Name
First
Last
Reasons for referral
Please advise us of any safeguarding or contact issues. It is important that this information is provided from the outset to enable planning of our services.
Please list any other information or issues we should be aware of at this stage here.

Maximum file size: 16.78MB

If you would like to send supporting documents with this referral please upload here before pressing the 'Submit' button.

Maximum file size: 16.78MB

If you would like to send supporting documents with this referral please upload here before pressing the 'Submit' button.

Maximum file size: 16.78MB

If you would like to send supporting documents with this referral please upload here before pressing the 'Submit' button.