CCA Referral Form (Clonmel)

Before we can advance to the next step, we will need a copy of the Declaration of Service. Please attach the Declaration of Service and relevant Court Orders to the referral form.

Date of Referral

1. Referrer Details

Referrer type *

Parent / Carer Legal Representative Court Services Other

If other, please specify

Title *

First Name *

Surname *

Role / Relationship to Child *

Full Address

Email Address

Tel / Mobile Number

Current Applications Before the Court

Has a court order directing a Children's Court Advocate / Voice of the Child report been made? *

Yes – order attached Yes – order to follow Pending Court Order Not Applicable

2. Details of Child / Children

Where the referral concerns more than one child, please complete a separate row for each child.

Full Name of Child	Date of Birth	Age

3. Legal and Court Information

Please provide details of the proceedings. Please attach copies of court order(s), if applicable, and of the Declaration of Service.

Court Name / Jurisdiction *

Court File Number

Name of Presiding Judge (if known)

Hearing / Next Listing Date

Type of proceedings *

Please tick all that apply:

Custody Access Guardianship

Has the court specified particular questions or topics on which the child's views are sought?

Yes No

If yes, please specify

4. Parent Information / Contact Details

Name of Parent / Guardian A

Contact Number & Email Address

First Language

Translator Required

Yes No

Name of Parent / Guardian B

Contact Number & Email Address

First Language

Translator Required

Yes No

5. Documents Attached

Please indicate which documents accompany this referral:

Court order directing the Children's Court Advocate / Voice of the Child reportCopy of Declaration of ServiceOther

Upload Declaration of Service

Upload Court Order(s)

Accepted formats: PDF, Word, JPG or PNG. Maximum 10 MB per file, 15 MB in total.

If other, please specify

CCA Referral Form (Clonmel)

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