Request For Assistance

FAMILY DETAILS
Name*
First Last
Telephone*
Email*
Address*
Street Address ZIP / Postal Code
Were you a child raised in care?
- Yes
- No
Do you have a disability?
- Yes
- No
Do you have other supports or are you involved with any other services?
- Yes
- No
Cultural background (optional)
Religion (optional)
Gender (optional)
- Male
- Female
- Nonbinary
Please list the names of children, their DOB, and what Care & Protection orders are in place (if any) — please include children’s surname if different from your own) (Orders can be Interim, Supervision, 2 year or 18 years)
REFERRAL SOURCE
Who is making this referral?
- Self Referral
- Family or Friend
- DCP (eg. Case Worker, Child Advocate)
- Other Government Dept (eg. Prison, Centrelink, Other)
- Health worker (e.g., hospital, GP, Child Health Nurse, Mental Health
- Community Services or Agency
- Other (specify):
Organisation Name
Name of Referrer
DoC Child Protection office the case is open to
Case Manager’s Name
Do you have a legal representative?
- No
- Yes
Legal Representative's Name
Team Leader’s Name
Date of Request
Date Format: DD slash MM slash YYYY
CAPTCHA
Email
This field is for validation purposes and should be left unchanged.

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Disclaimer:

Conditions of Use

By visiting and using this website developed by the Family Inclusion Network of WA (Fin WA), including any of the content or information it contains, the following terms and conditions apply. In using this website you agree to be bound by these terms and conditions. These terms and conditions apply to information which is presently available on this website and to information which will become available on it in the future.

Disclaimer

All advice and information on this website is given in good faith and is based on sources believed to be reliable and accurate at the time of release. Family Inclusion Network WA staff do not accept legal liability or responsibility for the content of the advice or information or any consequences arising from its use. A change in circumstances after a document is placed on the website may impact on the accuracy of the information. As well as this, materials may be maliciously vandalised. Fin WA cannot ensure the accuracy or security of any information or advice contained after publication on the website. The material on this website may reflect the views or recommendations of third parties which do not necessarily reflect the views of Fin WA, nor indicate a commitment to a particular course of action. The information provided on this website is provided for information purposes only. If you are a parent or family member using this website, you should seek legal advice when interpreting these materials and applying them to your individual circumstances.

Disclaimer – Other Sites

This website provides links to other websites as a service. Providing a link to another website does not constitute Fin WA’s endorsement or approval of the website, its owners or operators, or any information, products or services offered on the website. Fin WA will only accept links to non-commercial health sites and organisations deemed appropriate and relevant to the Fin WA client base. Fin WA reserves the right to deny cross-reference rights to sites and organisations. Fin WA have no control over the content of material accessible on any sites that are cross-referenced. All linked websites are accessed ‘as is’. It is the responsibility of the user to make their own decisions about the relevance or accuracy, currency and reliability of information found on those sites. Fin WA cannot guarantee that these links will work all of the time and has no control over the availability of the linked pages. Fin WA do not make any warranties or representations that material on other websites to which this site is linked does not infringe the intellectual property rights of any person anywhere in the world. Fin WA do not authorise, nor condone the infringement of any intellectual property rights contained in material in other sites by linking this Site to those other sites. If you use automatic language translation services in connection with this website you do so at your own risk. Fin WA can not assure the accuracy of the translations of the information presented.

Copyright

Some Family Inclusion Network WA materials featured on this website, including internet pages, documents and online graphics, and audio and video, may be protected by copyright law. Apart from any fair dealing for the purposes of private study, research, criticism or review, as permitted under the provisions of the Copyright Act 1968, resources should not be reproduced or re-used for any commercial purposes whatsoever without the written permission of Fin WA. Please acknowledge Fin WA when reproducing or quoting material from this site.

Viruses

Family Inclusion Network of WA do not represent or warrant that any files obtained from or through this website are free from computer viruses or other defects. Fin WA accept no liability for the presence of computer viruses or other defects, nor the interference with or damage to a user’s computer system, software or data occurring in connection with this website. Users of the website are encouraged to take appropriate and adequate precautions to ensure that whatever is selected from this site is free of viruses or other contamination that may interfere with or damage the user’s computer system, software or data.

Disclaimer:

Conditions of Use By visiting and using this website developed by the Family Inclusion Network of WA (Fin WA), including any of the content or information it contains, the following terms and conditions apply. In using this website you agree to be bound by these terms and conditions. These terms and conditions apply to information which is presently available on this website and to information which will become available on it in the future. Disclaimer All advice and information on this website is given in good faith and is based on sources believed to be reliable and accurate at the time of release. Family Inclusion Network WA staff do not accept legal liability or responsibility for the content of the advice or information or any consequences arising from its use. A change in circumstances after a document is placed on the website may impact on the accuracy of the information. As well as this, materials may be maliciously vandalised. Fin WA cannot ensure the accuracy or security of any information or advice contained after publication on the website. The material on this website may reflect the views or recommendations of third parties which do not necessarily reflect the views of Fin WA, nor indicate a commitment to a particular course of action. The information provided on this website is provided for information purposes only. If you are a parent or family member using this website, you should seek legal advice when interpreting these materials and applying them to your individual circumstances. Disclaimer – Other Sites This website provides links to other websites as a service. Providing a link to another website does not constitute Fin WA’s endorsement or approval of the website, its owners or operators, or any information, products or services offered on the website. Fin WA will only accept links to non-commercial health sites and organisations deemed appropriate and relevant to the Fin WA client base. Fin WA reserves the right to deny cross-reference rights to sites and organisations. Fin WA have no control over the content of material accessible on any sites that are cross-referenced. All linked websites are accessed ‘as is’. It is the responsibility of the user to make their own decisions about the relevance or accuracy, currency and reliability of information found on those sites. Fin WA cannot guarantee that these links will work all of the time and has no control over the availability of the linked pages. Fin WA do not make any warranties or representations that material on other websites to which this site is linked does not infringe the intellectual property rights of any person anywhere in the world. Fin WA do not authorise, nor condone the infringement of any intellectual property rights contained in material in other sites by linking this Site to those other sites. If you use automatic language translation services in connection with this website you do so at your own risk. Fin WA can not assure the accuracy of the translations of the information presented. Copyright Some Family Inclusion Network WA materials featured on this website, including internet pages, documents and online graphics, and audio and video, may be protected by copyright law. Apart from any fair dealing for the purposes of private study, research, criticism or review, as permitted under the provisions of the Copyright Act 1968, resources should not be reproduced or re-used for any commercial purposes whatsoever without the written permission of Fin WA. Please acknowledge Fin WA when reproducing or quoting material from this site. Viruses Family Inclusion Network of WA do not represent or warrant that any files obtained from or through this website are free from computer viruses or other defects. Fin WA accept no liability for the presence of computer viruses or other defects, nor the interference with or damage to a user’s computer system, software or data occurring in connection with this website. Users of the website are encouraged to take appropriate and adequate precautions to ensure that whatever is selected from this site is free of viruses or other contamination that may interfere with or damage the user’s computer system, software or data

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Request For Assistance

FAMILY DETAILS

REFERRAL SOURCE

Who we are

What we offer

Information & resources

Get Involved

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Website Terms, Conditions and Disclaimers​

Disclaimer:

Conditions of Use

Disclaimer

Disclaimer – Other Sites

Copyright

Viruses

Disclaimer:

Website Terms, Conditions and Disclaimers