Disabled Children & Participation Registers

Who are you?

Your status

Are you completing this on behalf of someone else?

Are you interested in adding your child to the Disabled Children's Register?

Are you interested in joining the parent participation register?

Child / Young Person's Details

Child's first name:

Child's last name:

Child's date of birth (dd/mm/yyyy):

Child's gender:

Child's Ethnic Origin:

Child's Address:

House name / no

Street name

Town / City

Postcode

School that your child / young person attends:

Which of the following best describes the child's additional needs?

If your child has been assessed, what is their main additional need:

Your Details

First name:

Required field.

Last name:

Required field.

Address:

House name / no

Required field.

Street name

Town / City

Postcode

Required field.

School or education setting:

Email address:

Please provide a minimum of either an email address or telephone number with which we can contact you

Telephone number:

Please provide a minimum of either an email address or telephone number with which we can contact you

How would you prefer to be contacted? Tick all that apply

Data Protection:

I agree for this information to be securely stored on the local authority Participation / Register of Children with Disabilities database. I understand that as a secondary use, the information provided may be shared with other council teams, or shared with partner agencies for statistical purposes only. I understand that this register is a voluntary one and I confirm I have been informed that I may request at any time for the information to be removed.

I have read and understood the data protection statement above

Please confirm that you have read and understood our data protection statement

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Disabled Children & Participation Registers

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