Youth Group Registration Form
Dear parent/carer,

Please fill in this form to update your details and to confirm that your child(ren) would still like to come to their youth group. We have transferred to an online form rather than paper-based as it is environmentally friendly and simpler to complete on your smart phone. If anybody has any issues filling in this online form, please get in touch with your group leader or call the office on 01189 594 594 - we can provide a paper copy if needed.

If you would like to make a donation to Autism Berkshire, we would really appreciate your support. The link to donate can be found here: http://www.autismberkshire.org.uk/donate/.

Thank you and Best wishes,

The Autism Berkshire Team

Have you attended an Autism Berkshire youth group before?
Which group does your child attend? *
Required
I agree that my child will attend all sessions, and that if my child does not attend regularly, their place may be given to another child on the waiting list. Each case will be considered on an individual basis if, for example, your child is ill. *
Required
Have you/do you access any other activities that Autism Berkshire offers?
Parent/carer (main contact) first name: *
Your answer
Parent/carer last name: *
Your answer
Address: *
Your answer
Postcode: *
Your answer
Parent/carer email address: *
Your answer
Parent/carer telephone number: *
Your answer
Tick the box that best describes you *
Required
Child's first name: *
Your answer
Child's last name: *
Your answer
What is your child's age? *
What is your child's date of birth? *
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What is your child's gender? *
Which school does your child attend? *
Your answer
Does your child have an Autism diagnosis? *
Please provide a date of diagnosis if your child has been diagnosed.
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YYYY
Does your child have any additional health needs? Please provide some details.
Your answer
I am happy for my child to receive first aid or emergency medical treatment by trained Autism Berkshire staff or medical authorities. *
Please list any activities your child enjoys/attends. *
Your answer
What are your child's interests? *
Your answer
Please describe any difficulties your child has with communication. *
Your answer
Does your child often become physically or verbally aggressive? *
If yes, please provide details.
Your answer
Does your child abscond from settings or people (e.g. school, home or groups)? *
If yes, please provide details.
Your answer
How did you hear about Autism Berkshire? *
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