0115 934 8451 / 07837 278 981 admin@rainbowpcf.org.uk

About You:

First name:
First name:
Address:
Postcode
City:
Phonenumber:
Email address:
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About your child(ren) with a disability or an additional needs

First name of child 1
Last name of child 1:
Date of Birth of child 1
What type of school does your child attend?
School
Gender of child
Disability or Additional Need:
First name of child 2
Last name of child 2:
Date of Birth of child 2
What type of school does your child attend?
School
Gender of child
Disability or Additional Need:
First name of child 3
Last name of child 3:
Date of Birth of child 3
What type of school does your child attend?
School
Gender of child
Disability or Additional Need:

Other Information

How did you find out about the forum?
Do you belong to any national support groups or networks?
Which of the following does your family access?

I consent to the infomations being used solely by the Rainbow Parents Carers Forum. This information will not be shared with any other organisation without my permission.

Member Signature

Optional:

if you are able, please help us to monitor our client base by completing this section so that we are able to target our services and funding more appropriately for the future:

Disability:

Please tick the boxes that apply to your child(ren) with an additional need or disability:
If there is any other information you feel we should know, please write it here: