Registration Form

Please enter all form fields that are starred*. These are required fields.

1Parent/Carer Details*

2Second Parent/Carer/Emergency Contact Details

3Child Details*

Please include details of all children in the family home.

Child 1

Additional Children?

YES +

4Media Consent*

I hereby give consent to the collection and use of images by photography or video recording to the names listed on this from. I further acknowledge that the images/recordings may be used in the following selected medias by Friends & Families to promote their services in the future - Facebook, Twitter, Instagram, Official Website, Partner Website, Other Online Advertising, Television, Newspaper (local media) & Printed Media (leaflets & posters). I understand that no personal information, such as names, will be used in any publications unless express consent is given. I also understand that my consent can be withdrawn at anytime by writing to Friends & Families of Special Children. I give this consent voluntarily.

YES NO

5Data Statement and Contact Preference*

Here at Friends and Families Of Special Children we take your privacy seriously and will only use your personal information to administer your account and to provide the services you have requested from us. Your information will not be passed to any other groups/third parties without your consent or unless we are legally bound to do so. However, we will use your information to contact you with details of our services we provide and with our monthly Catchup and Fundraising newsletters. If you consent to us contacting you for this purpose please tick to say how you would like us to contact you:

Post Email Telephone Text Message No Consent

6Where did you hear about us?

7Any Additional Information