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Disabled Children's Service 

Disabled Children's Register 

Your child's personal details

  1.  
  2. Any other religion (please specify)

  3. Any other ethnic group (please specify)

Family details

  1. Parent/Guardians name (first contact)

  2. Parent/Guardians name (second contact)

  3. Parent/Guardians address if different from above

     
  4. Number of siblings (brothers and sisters to your disabled child)

Information about people who support your child

  1. Name of your child's school/nursery/college

  2.  

Your child's needs

  1. 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.

Information sharing

  1. 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