(please complete all areas)
Full Name *
Home Address *
Postcode
Home Telephone
Mobile
E-Mail Address *
Child / Young Person (1) Information
Child(1) Name
Date of Birth
Nature of Special Educational Needs / Disability / Additional Needs
Does child(1) have an Education & Health Care Plan? Select an option Yes No
Does child(1) attend an education setting in Redcar & Cleveland? Select an option Yes No Home Educated
Child / Young Person (2) Information
Child(2) Name
Date of Birth
Nature of Special Educational Needs / Disability / Additional Needs
Does child(2) have an Education & Health Care Plan? Select an option Yes No
Does child(2) attend an education setting in Redcar & Cleveland? Select an option Yes No Home Educated
Child / Young Person (3) Information
Child(3) Name
Date of Birth
Nature of Special Educational Needs / Disability / Additional Needs
Does child(3) have an Education & Health Care Plan? Select an option Yes No
Does child(3) attend an education setting in Redcar & Cleveland? Select an option Yes No Home Educated
Child / Young Person (4) Information
Child(4) Name
Date of Birth
Nature of Special Educational Needs / Disability / Additional Needs
Does child(4) have an Education & Health Care Plan? Select an option Yes No
Does child(4) attend an education setting in Redcar & Cleveland? Select an option Yes No Home Educated
What support / information / activities would you like to access through SEND Family Voice
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Max Card
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I agree to my information being stored under General Data Protection Regulations (GDPR) and SEND Family Voice, Redcar and Cleveland Membership and Privacy Policies and to be contacted with relevant information via the following means.
Postal Information Select an option Yes No
Email Information Select an option Yes No
SMS Message Select an option Yes No
I am a parent/carer of a child or young person aged 0-25 who attends an educational setting in Redcar and Cleveland Select an option Yes No
I understand that information I give can be held by SEND Family Voice and I can request my information to be removed at any time by contacting SEND Family Voice, Redcar & Cleveland in writing (email accepted) Select an option Yes No
I agree to photos being taken at SEND Family Voice, Redcar & Cleveland events to be used for SEND Family Voice, Redcar & Cleveland promotional use. Select an option Yes No
I have read and understood the above consent requests and have marked them as appropriate Select an option Yes No
0 + 4 = ? Please prove that you are human by solving the equation *
