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Safeguarding & Welfare Form

Your Details

Your Name*

Your Address*

Your Contact Number*

Your Email*

Role / Organisation*

Person You are Referring

Name*

Address*

Contact Number*

Email*

Relationship to victim*

Ethnicity*

Details of Child/Children or Adults at risk

Names / age / club of victim/s*

Gender*

Ethnicity*

Parent / Carer Name*

Contact Details*

Details of Concerns

Type of Abuse*

Incident / Details*

Other Relevant Information

Further Information

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Registered Charity No 1192160

KTFC Community Trust, Polwell Lane, Burton Latimer, NN15 5PS

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enquiries@ktfccommunitytrust.com

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