Child Registration Form

Please complete this form fully to allow us to process the application efficiently.

Child's Personal Details
Child's surname*
Child's first names (in full)*
Previous Surnames*
Enter NONE if appropriate.
Title*
- Master
- Miss
- Ms
Date of Birth*
DD slash MM slash YYYY
Gender*
- Male
- Female
NHS number (if known)
Town and Country of Birth*
Home Address (inc. flat number if appropriate)*
Postcode*
Mobile Telephone*
Note: We use the mobile number for text messages. Text messages will automatically cease when the child is 11 years old.
Email address*
Enter Email Confirm Email
Please specify whose above email address this is, e.g. parent, guardian etc.*

Parent(s) / Carers*

Use the (+) button to add more rows if required.

Name of parent/carer	Has legal responsibility<br>(enter Yes or No)	Next of kin?

Legal responsibility for child
If the person(s) named above is(are) not the legal parent/guardian please enter the name and contact details of the person with legal responsibility.
Does the child have any special communication / mobility needs?*
- Yes
- No
If yes please select any mobility or communication aids used*
- Wheelchair
- Walking Aid
- Hearing Aid
- Large Print
- Lip Reading
- Braille
- British Sign Language
- Makaton Sign Language
- Other (please give details in the box below)
Other mobility/communication aids
Is the child currently:*
- A refugee
- An Asylum Seeker
- Neither of these
Is the child currently in care?*
- Yes
- No
Is the child a "Looked after child"?*
- Yes
- No
If the child is in care or "Looked after", in what capacity?
- Temporary
- Permanent
Is the child home educated?*
- Yes
- No
Name of child's nursery/school
Has the child or family either currently or in the past been known to Children's Services?*
- Yes
- No
Name of social worker
Social worker's phone number

Child's Personal Details