The MAZE Parenting Programme: Booking Form
The MAZE Parenting Programme is a structured specialist 12-week programme (10 weeks online) for parents/carers of children and young people with any kind of additional needs (with or without a diagnosis).
Sign in to Google to save your progress. Learn more
Name of person completing form *
Date *
MM
/
DD
/
YYYY
Parent / Carer 1 Details
Title *
Name *
Relationship to Child / Children *
NHS Number (if not already known, please visit https://www.nhs.uk/nhs-services/online-services/find-nhs-number to obtain) *
Email Address *
Mobile / Telephone Number *
Post Code *
Address *
Please state any additional needs of Parent / Carer, i.e., language, physical, etc.
Name of GP Practice *
Address of GP Practice *
Post Code of GP Practice *
Parent / Carer 2 Details
Title
Clear selection
Name
Relationship to Child / Children
Clear selection
NHS Number (if not already known, please visit https://www.nhs.uk/nhs-services/online-services/find-nhs-number to obtain)
Email Address
Mobile / Telephone Number
Post Code
Address
Please state any additional needs of Parent / Carer, i.e., language, physical, etc.
Name of GP Practice
Address of GP Practice
Post Code of GP Practice
Name of person wishing to attend the Programme *
Please confirm which group you would like to attend *
Required
Child / Children's Details
Name of Child / Young Person (1) *
Gender *
Date of Birth *
MM
/
DD
/
YYYY
Child's School *
Additional Needs (please specify) *
What level of SEND support is the child receiving *
Name of Child / Young Person (2)
Gender
Clear selection
Date of Birth
MM
/
DD
/
YYYY
Child's School
Additional Needs (please specify)
What level of SEND support is the child receiving
Clear selection
Name of Child / Young Person (3)
Gender
Clear selection
Date of Birth
MM
/
DD
/
YYYY
Child's School
Additional Needs (please specify)
What level of SEND support is the child receiving
Clear selection
Where did you hear about the MAZE Group? *
Name of Referrer (if not self-referral)
Organisation of Referrer (if not self-referral)
Referrer's Email Address (if not self-referral)
Referrer's Mobile / Telephone Number (if not self-referral)
Any other agencies involved? (e.g., Social Care, EWMHS, Family Solutions, etc.)
Any Additional Information
Terms & Conditions
1. Accessing our Services
Applications to access The MAZE Group Parenting Programme are through referrals and are considered on completion of a booking form.
On receipt of the completed booking form, The MAZE Group will make contact to acknowledge and advise the likely date of a place offer. Please note that completion of the booking form does not automatically guarantee you a place on the next Programme.
Under the terms of our funding, places will be prioritised to those parents residing in North-East Essex.
Any person unable to attend week one, should contact The MAZE Group as soon as they are able and confirm whether they require the place held open. If The MAZE Group are not informed, and there is non-attendance, we reserve the right to offer this place to the next person held on our waiting list.
You may request an opportunity to repeat the course, but we require a resubmitted form with this request marked on it. This will ensure parents are able to attend again, taking into account new referrals from people who are waiting for a place.

2. Prior to Attending our Programme
Prior to attending our Programme you will be asked to complete a questionnaire. This will enable The MAZE Group to tailor the Programme to the needs of those attending.

3. Completion of the Programme
On completion of the Programme, The MAZE Group would be grateful for an evaluation form to be completed. The facilitators will discuss this further with you during the course. Under the terms of our funding, we are required to obtain feedback from attendees of our Programme.
Please tick this box to confirm that you have read and understood The MAZE Group CiC's Terms & Conditions *
Required
Privacy Policy
The MAZE Group CiC takes data protection and confidentiality very seriously, and complies with the Data Protection Act 1998. They are committed to ensuring that all personal data is stored securely, and will not be passed on to third parties unless instructed to do so. Please refer to our Privacy Policy on the website for full details on the data we collect, store and process: https://www.themazegroup.co.uk/wp-content/uploads/2019/09/MAZE-Privacy-Notice.pdf
Please tick this box to confirm that you have read and understood how The MAZE Group CiC collects, stores and processes your personal data. You can withdraw your consent at any time by emailing amanda.towns@themazegroup.co.uk. Please note that withdrawing consent may result in your place being withdrawn on the Programme. *
Required
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy