(Date of Birth)
(Home contact number)
(Work contact number)
Does your child have any Allergies? *
Does your child have any special Dietary Needs? *
Name & Address of Doctor: *
Doctors Telephone Number: *
Language spoken at home: *
Brief madrasah history:*
Name of School/s Attended: *
Does your child have a statement/EHC plan of Special Educational Needs?
Please provide a brief summary of your child's needs?
Does your child require any personal care?
How is your child best supported?
Please be aware that in order to meet your child's needs fully we may require additional information e.g. EHC/Statement, Professional agency reports.
Please use the space below for any other Additional Information that you think may be relevant
ALL INFORMATION GIVEN WILL BE DEALT IN STRICT CONFIDENCE AND UNDER THE DATA PROTECTION ACT