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Disabled Children's Service

Disabled Children's Register

Your child's personal details

Your child's surname
Your child's first name
Date of birth (DD/MM/YYYY)
Gender
Address
Post code
Telephone
Email
Faith
Any other religion (please specify)
First language
Ethnicity
Any other ethnic group (please specify)

Family details

Parent/Guardians name (first contact)
Relationship to child
Email address
Contact number(s)
Parent/Guardians name (second contact)
Relationship to child
Email address
Contact number(s)
Parent/Guardians address if different from above
Parent/Guardians post code
Other child's name (1)
Gender
Date of birth (DD/MM/YYYY)
Disability if applicable
Other child's name (2)
Gender
Date of birth (DD/MM/YYYY)
Disability if applicable
Other child's name (3)
Gender
Date of birth (DD/MM/YYYY)
Disability if applicable
Number of siblings (brothers and sisters to your disabled child)

Information about people who support your child

Name of your child's school/nursery/college
Child's GP
GP's address

Your child's needs

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.
Other

Information sharing

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.

* Required Field

Contact

Lin Green

Centre Manager

Heathway Centre

512a The Heathway

Dagenham

RM10 7SJ

Phone: 020 8724 1911

Mob: 07854 958 654

Email: lin.green@lbbd.gov.uk