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PACT Child Witness Referral Formadmin2021-05-26T03:36:34+00:00

Request PACT Support for a Child

PACT is committed to impartially supporting child victims who have to give evidence. To request support for children or young people, fill in the online form below or call 1800 449 632.

Volunteer PACT Support Persons use the information provided to prepare and support child witnesses for the criminal court process. Where possible, please complete each section of the referral form and add any relevant supporting information (potential safety concerns, family dynamics, child living with the defendant etc.), in the ‘Further Information’ section towards the end. Once we receive a referral, PACT will allocate it to one of our PACT Support Persons who will be in touch with the family.

PLEASE COMPLETE A SEPARATE REFERRAL FORM FOR EACH CHILD

IMPORTANT REMINDER: This online referral is NOT to be utilised by QPS. All QPS referrals are to be submitted via QPrime and tasked 3307 as per the QPS Policy.

PACT Child Witness Referral Form

Occurrence (QP) #:

Pros. index / DPP ref #:

Date submitted: *

PART 1: Child's Details

Child's given name(s): *

first and middle name(s)

Child's last name: *

Family name

Child's date of birth: *

DD/MM/YYYY

Child's gender:

Child's Ethnicity:

*If other ethnicity, describe here:

What type of witness is the child?

Child's current residential address: *

Child's address

Suburb and State: *

Postcode: *

Child's current phone no:

If none, leave blank

Child's email:

If none, leave blank

PART 2: Carer's Details

Carer's given name(s):

Carer's first and middle name(s)

Carer's last name:

Carer's family name

What relationship is the carer to the child?

*If other relationship, describe here:

Carer's current residential address:

Suburb and State:

Postcode:

Carer's current phone no:

Carer's email:

PART 3: Parent Details

Mother's given name(s):

Mother's first and last name(s)

Mother's last name:

Mother's family name

Father's given name(s):

Father's first and middle name(s)

Father's last name:

Father's family name

PART 4: Child Safety Officer Details

*Skip this part if not applicable

Child Safety Officer's given name(s):

CSO's first and middle name(s)

Child Safety Officer's last name:

CSO's family name:

Child Safety Office:

Child Safety Officer's current phone no:

Child Safety Officer's email:

PART 5: Police Officer's Details

Police Officer's given name(s):

Police Officer's first and middle name(s)

Police Officer's last name:

Police Officer's family name

Rank:

Reg. no:

Police station:

Police Officer's phone no:

Police Officer's fax no:

Police Officer's email:

PART 6: Defendant's Details

Defendant's given name(s):

Offender's first and last name(s)

Defendant's last name:

Offender's family name

Defendant's date of birth:

DD/MM/YYYY

What date was the arrest made?

DD/MM/YYYY

What is the defendant's relationship to the child witness?

Natural parent

Step parent

Foster parent

Relative

Sibling

De Facto

Family friend

Unknown

No relationship

Professional

PART 7: Court/Case Details

Court details:

Committal mention

Committal Hearing

Trial

Mention

Directional hearing

Pre-recording

Awaiting indictmentAwaiting indictment

Court date:

DD/MM/YYYY

Court time:

Court location (eg. Cairns District, Brisbane Magistrates):

List charges in which this child is required to give evidence:

Are there any problems with this case that are not listed on this form?

Yes

Further information:

eg: Trial number, date committed for trial, any special instructions

PART 8: Submitted By

Given name(s) of person submitting this referral: *

First and last name(s) of person submitting referral

Last name of person submitting this referral: *

Family name of person submitting referral

Organisation of the person submitting referral:

*If applicable

Phone number of person submitting referral: *

Email of person submitting referral:

The complainant/witness has given permission for the Office of the Director of Public Prosecutions, the Queensland Police Service, and Protect All Children Today to obtain, share and provide information between organisations for the complainant/witness listed in this referral form. *

Consent received

If you are human, leave this field blank.

THANK YOU FOR YOUR REFERRAL TO PACT

PACT acknowledges the Traditional Custodians of the land on which we live, work and study. We pay our respects to local Indigenous Elders past, present and emerging and recognise the strength, resilience and capacity of all Aboriginal and Torres Strait Islander people.