FOAH APP FORM
Form Description
Name of Child (first & surname) *
Your answer
Child's Date of Birth *
MM
/
DD
/
YYYY
Parents Names (including surnames) *
Your answer
Sibling Names and Dates of Birth
Your answer
Address (including postcode) *
Your answer
Contact Number *
Your answer
Email Address *
Your answer
Has your child received an Autism diagnosis *
Required
Date of Autism diagnosis/Date started going through Autusm diagnosis process *
MM
/
DD
/
YYYY
Paediatrician Name *
Your answer
How did you hear about us? *
Your answer
On occasion photos may be taken at events, please select if you are happy for your child(ren) to be photographed *
Required
Information is stored in a secure drive which only the Chair & Secretary have access to, as we are a children's charity we are required to maintain the information for safguarding and child protection purposes.

Please tick to acknowledge

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Required
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