Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Your child's name

First Name

Last Name

First child's date of birth *

MM

DD

YYYY

Does your child have an Education and Healthcare plan? *

Yes

No

Does your child attend an education setting in North Yorkshire? *

Yes

No

Second child's name

First Name

Last Name

Second child's date of birth

MM

DD

YYYY

Does your second child have an Education and Healthcare plan?

Yes

No

Does your second child attend an education setting in North Yorkshire?

Yes

No

Third child's name

First Name

Last Name

Third child's date of birth

MM

DD

YYYY

Does your third child have an Education and Healthcare plan?

Yes

No

Does your third child attend an education setting in North Yorkshire?

Yes

No

Child/young person's name

First Name

Last Name

Fourth child's date of birth

MM

DD

YYYY

Does your fourth child have an Education and Healthcare plan?

Yes

No

Does your fourth child attend an education setting in North Yorkshire?

Yes

No

What support / information / activities would you like to access through PCV? *

Parent to parent support

Local events

Training

Information sessions

Conferences

Signposting

Max Card

Family events

Other

Contacting you *

I agree to my information being stored by Parent Carer Voice under General Data Protection Regulations (GDPR) and the Parent Carer Voice Membership and Data Protection / Confidentiality Policies and to be contacted with relevant information via the following means:

Post

Email

SMS

Consents *

Please tick all that apply.

I am a parent/carer of a child or young person aged 0-25 who attends an educational setting in North Yorkshire.

I understand I can request my information to be removed at any time by contacting Parent Carer Voice in writing.

I agree to my photo being taken at Parent Carer Voice events to be used for Parent Carer Voice promotional use.

I have read and understood the above consent requests and have marked them as appropriate. *

Yes