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FREE Sign-Up – parents and carers, please complete this form.

New memebrs, 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 Sign-Up 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 membership.     

 

Details for your children 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.
   
 

Invalid format.
     
 
 
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)

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

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 Sign-Up 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 Sign-Up 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 member 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 member 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 Removal form

 

 

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