If you would like to make a request under Clare's Law, you can do so using this online form. If you haven’t already we recommend you read more about the Domestic Violence Disclosure Scheme and download our detailed leaflet on the Clare’s Law information page.

Please note:

  • You should only use this form if the person you think is at risk lives in the West Midlands. If the person lives outside of our policing area, find the nearest police force to them on the national police website.
  • This form should only be used by members of the public and external agencies. Police employees should follow usual procedures or contact their Safeguarding Team for advice.

IMPORTANT - PLEASE READ

If you feel that you or anyone else is in immediate danger please do not use this form and speak to us as soon as possible by calling 999.

When filling in the form please provide as much detail as you can as this will help us when carrying out our checks. Due to the sensitive nature of these details please be aware of your surroundings and make sure other people cannot see or record the information you are entering.

1. Your details

Any fields marked with * are mandatory and must be completed.

Please include your full name, including any middle or other names used, i.e. maiden name.

2. Person of concern

Please enter the details of the person whose behaviour is concerning you

Please include any other names the person has used.

3. Details of the person at risk

Please enter the details of the person you believe may be at risk

Please include the person's full name, including any middle or other names used, i.e. maiden name.

4. Details of children

Please include the child's full name, including any middle or other names used

Please include the child's full name, including any middle or other names used

Please include the child's full name, including any middle or other names used

Please include the child's full name, including any middle or other names used

Please include the child's full name, including any middle or other names used

Please include the child's full name, including any middle or other names used

5. Relationship between the subject and the person at risk

Please provide as much detail as possible including the reason you are making this application, any concerns you have and a description of the relation between the person of concern and the person at risk.

Feedback

Rate this page (1 star poor – 3 stars excellent).
Tell us about your experience on the website.
From time to time, we contact people to ask them about their experience on the website. If you’d like us to contact you, enter your name and/or your email address.
*Required field.