Families First Assessment Family Case Registration Form

Families First Assessment Family Case Registration Form

Hertfordshire Families First Assessment

Family Registration Form

This form will start the registration of the family for the Families First Episode.

Please ensure that all sections of the form are completed. Failure to do so will delay registration.

Details of CHILDREN and YOUNG PEOPLE in the family (including unborn)
Forename / Surname / Unique Pupil Number (UPN)
(if known) / Date of birth or expected date of delivery
(DD/MM/YYYY) / Gender
(M/F) – delete as appropriate / Address / Ethnicity / Religion / Disability
Y/N (delete as appropriate)
/ *Tick if child/YP
To be included
In assessment
DD/MM/YYYY / M/F / Y/N / ☐ /
DD/MM/YYYY / M/F / Y/N / ☐ /
DD/MM/YYYY / M/F / Y/N / ☐ /
DD/MM/YYYY / M/F / Y/N / ☐ /
DD/MM/YYYY / M/F / Y/N / ☐ /
DD/MM/YYYY / M/F / Y/N / ☐ /
DD/MM/YYYY / M/F / Y/N / ☐ /
DD/MM/YYYY / M/F / Y/N / ☐ /
DD/MM/YYYY / M/F / Y/N / ☐ /

Only the Children/Young people/Adults ticked will be brought forward into theonline assessment

Details of PARENT(S)/ CARERS and any other SIGNIFICANTADULTS within the Family
Forename / Surname / Date of birth
(DD/MM/YYYY) / Gender
(M/F) – delete as appropriate / Address / Other contact details
(if known)
e.g. phone number,
email address / Parental Responsibility
Y/N (delete as appropriate) / Relationship to Child/ren
(e.g. Mother, Father) / *Tick if adult is to be
In assessment
DD/MM/YYYY / M/F / Y/N / ☐ /
DD/MM/YYYY / M/F / Y/N / ☐ /
DD/MM/YYYY / M/F / Y/N / ☐ /
DD/MM/YYYY / M/F / Y/N / ☐ /
DD/MM/YYYY / M/F / Y/N / ☐ /
DD/MM/YYYY / M/F / Y/N / ☐ /

Please note the reason for Families First Episode cannot be changed once registration is completed.Please choose reason from the picklist below by clicking on choose an Item

Reason For Families First Episode / Choose an item.
Additional Notes

Please note the Primary Need cannot be changed once registration is complete - Please choose Primary Need from the picklist below.

In this section ONLY enter the family members that ARE to be included in the Assessment

Please select main presenting need for each family member within the Families First assessment
(all other additional identified needs can be added from within the episode)
Name / Primary Need (main presenting need) Click on choose an Item
Choose an item. /
Choose an item. /
Choose an item. /
Choose an item. /
Choose an item. /
Choose an item. /
Choose an item. /
Choose an item. /
Step down from Safeguarding? / Yes No
Do any of the children/young people have a caring responsibility? / Yes No
If Yes Please highlight Child/young person’s name
CONSENT – THIS BOX MUSTBE COMPLETED
I verify that I have obtained verbal consent from the parent/carer/young person to begin Families First Assessment process.
Are those that hold Parental Responsibility(PR) for the child (ren) aware of this contact? Yes ☐ No ☐ Unknown ☐
Have those that hold Parental Responsibility (PR) consented to information being shared with children’s services?
Yes ☐ No ☐ Unknown ☐
Have those that hold Parental Responsibility (PR) consented to agency checks being made? Yes ☐ No ☐ Unknown ☐
DATE CONSENT OBTAINED: DD/MM/YYYY
THIS CONSENT BOX MUST BE COMPLETED, OR THE PROCESSING OF YOUR FORM WILL BE DELAYED
Details of Key Worker
Forename
Surname
Organisation
Job title / role
Work Address
Date form completed / DD/MM/YYYY
School number (where applicable)
Telephone number
Email address

Instructions for submitting your form can be found below:

Please make sure that you have completed the consent box above before submitting your form
Once your form is completed, please email it to:
with the subject heading Family Registration Form
Please do not email this form to any other email address.
When sending your form, please ensure that it is password-protected.
Passwords should be sent in a separate email to the same email address as above.
Instructions on how to password protect a Microsoft Word document can be found here on the Microsoft Office website.
There are a number of different versions of Microsoft Word, so please select the appropriate instructions for your version.
If you are not sure which version of Microsoft Word you are using, you can find out by following these instructions.
Families First Helpdesk will enter this information on EHM
You will receive an email within 48 hours confirming that this has been completed.
*The Keyworker will then have access to the Family on EHM – Families First Assessment.
(*Keyworker must be a registered EHM user)
Should you require any support with completing this form please contact
Families First Helpdesk on 01438 737575 or Email:

Families First Assessment – Family Case Registration Form Sept 2016