PREMIER LEAGUE

PREMIER LEAGUE
Form 23
NOTIFICATION OF REFERRAL (Rule S.21)
To:
And to:
The Head of Safeguarding, The Premier League
The Head of Education and Child Protection, The Football Association
We,
Football Club, hereby notify you that a referral has been
made to the police or to Social Services in respect of a Child involved in an Activity. Particulars are as follows:
The Child
Full name
Address
Post Code
Date of birth
The Activity
Nature of the Activity Date Time
Place
The allegation or incident referred
PREMIER LEAGUE FORMS
The police
Date and time of referral
Address
Name and rank of officer
Summary of advice received
Police force
Telephone
Social Services
Date and time of referral
Address
Name and designation of officer
Summary of advice received
Local authority name
Telephone
ISA and/or County Safeguarding Lead
Date and time of referral
Address
Name and designation of officer
Summary of advice received
Local authority name
Telephone
Signed
Position
Date
265