Access to Records Request – Personal Records

Please complete and return this form along with the required ID to:

Action for Children, Access to Records Service,

231 Camberwell New Road, Camberwell, SE5 0TH

We recommend this form is sent by a tracked service,or if you would prefer to email your application to usatplease be aware that we cannot accept emails over 10MB. Please contact us by email or telephone if you require further assistance 0207 701 1144.

Title ______First Name______Surname______
Date of birth:______Email______
Address ______
______Postcode______
Telephonenumber______Mobile number______
I am requesting the following: (please complete as applicable):
Residential Care Records Child Migrant Records
Previous name whilst in Action for Children care______
Dates in care: from ______to______Name of Care home______
Genealogy/Family history requests: Please do not complete this form – please see our website pages relating to Genealogy enquiries (please note we do make a charge for this service)
Adoption Records Please tick if you are an agency requesting records on behalf an adoptee
Name at birth (if known)______Name on adoption______
Date of adoption (if known)______
Action for Children service/project/centre
Name if different to above whilst receiving a service:______
or
Name of person on whose behalf you are applying: ______
Date of Birth:______Your relationship to this person______
Name and address of service/project/centre______
______Dates service received: from ______to______
If you are a PARENT requesting personal information relating to a child under 16, please include verification of your ID as below and in additionproof of parental responsibility *
Please send copies of the following ID to verify your identity - we cannot proceed without this information
A copy of One of the following (Please tick) / PLUS(Please tick where enclosed)
  • Photo Driving licence
  • Passport
  • *Proof of parental responsibility*
(eg. Full birth certificate of child, court order or parental agreement) /
  • A copy of a utility bill/bank statement which shows your current address. This should be no older than 3 months
  • Any other certificates where there has been a name change though marriage, deed poll etc., where applicable

If you cannot provide any of the above please contact us to discuss other forms of acceptable identification
I am requesting access to records held by Action for Children:
Signature ______Date_____ /_____ /______
Document Name & Version No / 1 / Date