Family Information

 

1. Child or young person's name *

 

2. Child or young person's date of birth *

   DD/MM/YYYY 
 
 

3. Child or young person's gender *

 

4. Parent or carer's name or names *

*
 

5. Family address and postcode

 

6. Contact details

 

7. Do we have consent to contact you by: *

 

8. Please briefly tell us about your child's condition or diagnosis (for example 'Down syndrome, heart condition, feeding issues').

 

9. Are there any health conditions or other issues that are relevant for us to know about for organising and running activities and trips? *

 

10. Does your child/young person have any allergies? *

 

11. Sunshine and Smiles is dedicated to providing the support that is needed by the families we meet. Do you have any feedback on the support we provide or is there anything you would particularly like to see as part of our groups and family support?

 

12. We often take photos or video/audio recording at both our online and face to face groups, or collect written feedback. We would like to ask consent for this material to be used by Sunshine and Smiles- Leeds Down Syndrome Network as well as partner organisations (such as session providers or funding organisations). We would also like permission for any photos, videos or quotes that you yourself provide to us to be used in the same way. More information on this can be found here .

Do you agree and give permission for Sunshine and Smiles- Leeds Down Syndrome Network to use photos, footage and quotes as outlined above? *

 

13. Do you agree and give permission for Sunshine and Smiles- Leeds Down Syndrome Network to hold relevant and necessary personal information in accordance with our privacy policy? *