<p> Ref; Family Group Conference Request form</p><p>Ideally this form must be completed with the family and they should always be given a copy of the completed form Yes </p><p>The purpose of a Family Group Conference is: For the family to hear information from the service providers about the support and service they could offer the family For the family to consider any concerns about the children/young people and the strengths which exist within their family For the family to create an action plan that supports the children/young people For the requesting professional to agree the families plan, and confirm that it does not place the children at risk For the family to have the opportunity of a review Family Group Conference The person requesting the service must agree to attend the Family group Conference</p><p>When all concerned have signed/approved this form (see below) please send it to:-</p><p>Early Help Hub [email protected] Tel; 01872 322277</p><p>Brian Sharp, Family Group Conference Professional Lead, Room 119, St Clare, Penzance, TR18 3QW email: [email protected] – Mobile: 07772603114 </p><p>1. Person requesting the Family Group Conference</p><p>Name Job Title</p><p>Address & Postcode Landline</p><p>Team Agency</p><p>Mobile Email</p><p>2. Children/Young People:</p><p>Name DOB Gender Ethnicity/first language </p><p>Address & Postcode</p><p>Name DOB Gender Ethnicity/first language </p><p>Address & Postcode</p><p>Name DOB Gender Ethnicity/first language</p><p>Address & Postcode</p><p>Name DOB Gender Ethnicity/first language </p><p>Address & Postcode 3. Carers/Family Members/Friends:</p><p>Name Relationship Address & Postcode DOB Ethnicity/first Tel Number & Email to child language</p><p>4. Other Professionals involved:</p><p>Name Job Title Agency Tel Number & Email</p><p>5. Are there any known risk factors (people, pets, property and location) that FGC Coordinators need to be aware of when visiting family members? Yes/No? If 'yes' please give details.</p><p>6. What are the child’s or young person’s wishes?</p><p>7. A brief description of the current situation As part of the safety plan what ‘concerns’ would the FGC address</p><p>8. What is working well for the family and what do they hope the FGC will achieve?</p><p>9. What question(s) does the Family Group Conference need to address Is there anything which could not be agreed in the family plan (bottom line)?</p><p>Are any of the Children/Young People;</p><p>SEN statement or pending Yes No Subject to a CP Plan Yes No </p><p>'Looked after' by the LA Yes No A Young Carer Yes No </p><p>Subject to court proceedings Yes No Subject to a CAF Yes No </p><p>Subject to a Chin Plan Yes No Early Help Services Yes No </p><p>If yes, please give details. Also please give details of any particular needs of anyone to be included.</p><p>Any Other Information: Parent/carer Parent/carer</p><p>Young person's </p><p>Person requesting FGC signature: Print name: Contact No: </p><p>Consent</p><p>Ensure consent is obtained from the family for a Request and for sensitive information to be shared with professionals in the Early Help Hub. Please note anybody over 13 years, who is deemed competent, can give their own consent. This may be with or without parental consent. </p><p>By ticking this box, you are confirming that the following verbal consent has been given: “I agree to this Request and to my information being shared with agencies that are part of the Early Help Hub response”: </p><p>☐ </p><p>Are Parent(s)/Carers consenting to this Yes No Unknown Not Applicable request? delete as appropriate</p><p>Is the Child/Young Person consenting to the Yes No Unknown Not Applicable Request? delete as appropriate</p><p>Name of person giving consent </p><p>Date</p>