Child Protection intake (INTERNAL ONLY)

Duty Lawyer Service Referral Date

Client first name

Client last name

Client date of birth

Client phone number

Other party first name

Other party last name

Other party date of birth

Detals of additional other parties

If there are no additional other parties, please write NA

Child #1 first name

Child #1 last name

Child #1 date of birth

Names and dates of birth of other depenbdents

If there are no additional children, please write NA. Additional children will need to be added into CLASS and Actionstep as separate contacts

Children's Court Location

Date of Children's Court Hearing

Type of Hearing

VLA Referral ID (CP)