UPG & FAMILY SUPPORT CHILDREN’S CENTRE ENROLMENT FORM

PARENT 1 – All sections need to be filled in to fully complete registration

Gender
Are you a Lone Parent?
Are you currently Employed?

PARENT 2 – All sections need to be filled in to fully complete registration

Gender
Are you a Lone Parent?
Are you currently Employed?

CHILD 1 – All sections need to be filled in to fully complete registration

Gender

CHILD 2 – All sections need to be filled in to fully complete registration

Gender

CHILD 3 – All sections need to be filled in to fully complete registration

Gender

NANNY/CHILDMINDER – All sections need to be filled in to fully complete registration

Gender

ABOUT YOUR FAMILY

The following section asks questions to help us understand your needs and those of your family so that we can offer you appropriate support and make sure you have access to the services you need.

Questions about your family’s housing support needs

Do you need support with any housing difficulties?
Are you living in temporary housing?

Questions about your family’s financial support needs

Are you living in a household where no one is working?
Is anyone in the household claiming benefits? Please state (not child tax credit)
Do you have ‘No Status’? If so, please let us know why:
Are you or your family seeking asylum in the UK?

Questions about your child/ren and the support they need

Do you or your children have a specialist early intervention health visitor?
Children_support_needed_Q1
Are any of the children on this form currently in foster care?

Questions about you and the support you need

Have you received or would you like support for your mental health?
Have you ever been affected by domestic abuse?
Do you need support in speaking English? (i.e. an interpretor)
Do you need support with reading and writing in English?
Would you like more information about our family support services?
Would you like information on our parenting programmes?
Would you like information on our adult education classes?
Do you receive Healthy Start Vouchers?
Would you like help in registering for a nursery place?


Other – Please sign and date below to fully complete registration

DATA PROTECTION

UPG and Family Support are committed to protecting your personal data and being clear and honest about how your data is used. Your data will only be used for the purposes of monitoring attendance, your child’s development (additional consent will be requested) and anonymous, confidential reporting to our governing and statutory bodies. By enrolling at any Hammersmith and Fulham Children’s Centre you are consenting for your personal data to be stored on the Estart (Children’s Centre data base) which can only be accessed by Family Support authorised users in the London Borough of Hammersmith and Fulham.

Your data will be retained electronically until your youngest child turns 5. We will not share your data with a 3rd party without further consent from you, with the exception of safeguarding where we have a statutory obligation to report any safety concerns around a child. You have the right to request to see how your personal data is stored and may at any time view our privacy policy and have the right to withdraw your consent at any time.

Please tick consent box, sign and date below to fully complete registration

By signing I consent for my family’s personal data to be stored and used as outlined above.