LPCF Subscribe

FREE subscription – parents and carers, please complete this form.

New subscribers, please complete the form in full.

To update your personal information, please complete the form in full.

To amend your personal information (Eg Change of address) , complete the ‘Parents/Carers’ section first and then your amendments.

Professionals - please use this Professional Subscription Form

Parents / Carers

Carer 1		Carer 2
First Name	* Required.	First Name
Surname	* Required.	Surname
Tel - Home		Tel - Home
Tel - Mobile		Tel - Mobile
Email	Invalid format.	Email	Invalid format.
Address		Address
Post Code		Post Code
Carer Role Eg Mother / Grandparent		Carer Role Eg Father / Aunt

Please tick if this is an amendment to your current subscription.

Details for loved one with SEN/Disability

1st Name

Male/

Female

Date of Birth (DD/MM/YYYY)

Primary

Disability / SEN

Secondary

Disability / SEN

Other Disability/SEN Details / Additional information

Invalid format.

If you have more than 3 children please just add details at the end.

Other Information.

How did you find us? (please tick one)

Referred?

Tick if you were you referred by an agency (If no, please skip down to "Communication")

If so, please provide details of the agency or contact person

Communication

Please choose your preferred method of communication from our charity.
The recommended method is by email which will help us keep postage costs down.
However, if you wish to opt for postal communication, we would appreciate a donation of £10.00 per year.

Email

(Recommended)

You will probably receive approximately 10-15 Emails per annum
eg notifications, newsletters, events and consultations.

Website

Nothing will be sent to you unless of very high importance or subscription reminders.

Additional Notes

If you would like to add further relevant information, please use the box below.

Additional Carers.

If there are other carers helping look after your loved one (eg Grandparents, Aunts, Uncles), please welcome them to complete the online subscription so that they can also benefit from receiving regular communication from us

(NB the larger our registered community of parents and carers, the stronger the influence for agencies to listen to our views. We would welcome you to encourage other parents and carers to register with us. Together we can build a community that can benefit families raising children with SEN and disabilities).

DATA PROTECTION STATEMENT
The information gathered is collected and stored in paper and electronic format in compliance with the
current Data Protection Act in the UK and with in current EU Data Protection directives.

All of the information provided is kept securely and IS NOT SHARED WITH ANY 3rd PARTIES unless required by law.

A subscriber may, at any time, request to be removed from our data systems and
their records will be expunged unless there are other legal precedents.

A subscriber may change how we communicate with them or opt to use the website only.

All data will be reviewed periodically to check for accuracy.

Additional Notes

If you wish to be removed (deleted) from our database, please use our unsubscribe form

Attended Event	Leaflet / Poster	Referred	LPCF Volunteer
Friend	Website	Via Professional	Via Survey
Other	Other Detail