Adult Services (North) Referral Form

Only complete the below referral form if you are a social worker or professional working in a PAC-UK subscribing local authority (see below list). Non-subscribing local authorities must contact the PAC-UK Advice Line (0300 1800 090) prior to completing this referral form. If you are making a One Adoption referral please click here to be redirected to the correct referral form.

We have partnerships with 78 local authorities stretching from Northumberland and York in the north to Haringey and Hertfordshire in the south; and in total more than 100 local authorities benefit from our expertise every year.


Correct as at April 2024.

London/South

Adopt London East
Barking & Dagenham
Havering
Newham
Tower Hamlets

Adopt London North
Barnet
Camden
Enfield
Hackney
Haringey
Islington

Adopt London South
Croydon
Greenwich
Kingston
Lambeth
Lewisham
Merton
Richmond
Southwark
Sutton
Wandsworth

Adopt London West
Brent
Ealing
Hammersmith & Fulham
Hounslow

Coram - Ambitious for Adoption
City of London
Harrow
Hillingdon
Kensington & Chelsea
Redbridge
Waltham Forest
Westminster

Other
Hertfordshire

North London Fostering & Permanency Consortium
Barnet
Camden
Enfield
Hackney
Haringey
Islington

Special Guardianship Contracts
Lambeth
Waltham Forest

Special Guardianship Support Service
Cumbria
Isle of Wight
Kent

Leeds/North

Adoption Counts
Cheshire East
Manchester
Salford
Stockport
Trafford

Adoption in Merseyside
Knowsley
Liverpool
Sefton
Wirral

Adopt North East
Gateshead
Newcastle upon Tyne
North Tyneside
Northumberland
South Tyneside

Adoption Now
Bolton
Blackburn with Darwen
Bury
Oldham
Rochdale
Tameside

One Adoption North & Humber
East Riding of Yorkshire
Hull City Council
North East Lincolnshire
North Lincolnshire
North Yorkshire
York

One Adoption South
Barnsley
Doncaster
Rotherham
Sheffield

One Adoption West Yorkshire
Bradford
Calderdale
Kirklees
Leeds
Wakefield

Together for Adoption
Cheshire West & Chester
Halton
St Helen’s
Warrington
Wigan

Other
Birmingham
Lincolnshire CC
Sunderland


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

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

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.

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.

Adult Services (North) 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 0113 230 2100 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?
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.
This should include anyone listed in 'other household members' and 'details of children' sections of this form.
If applicable for this referral, how many months ago was the adoption order made?
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.