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Any other religion (please specify)
Any other ethnic group (please specify)
Parent/Guardians name (first contact)
Parent/Guardians name (second contact)
Parent/Guardians address if different from above
Number of siblings (brothers and sisters to your disabled child)
Name of your child's school/nursery/college
Please give details of your child's disabilities. You may use sections as applicable, give details in the box next to the choice. This is so we may register your child under the right category or categories. Thank you.
Are you happy for us to share basic information about your child with agencies that are members of the Barking and Dagenham Children's Trust.
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