Family Voice Membership Form
The following details will be entered onto our database, and you will be signed up to our monthly newsletter detailing the work that we are currently undertaking, with information about any upcoming events you may find useful. Your details will not be shared with any other organisation and will be stored in accordance with GDPR legislation. You can withdraw your details from the database at any time by sending a request to our registered address, or unsubscribe from our newsletter using the link on the bottom of the email.
This information helps us to tailor our services to meet the needs of our beneficiaries and target out work where needed. Some information such as numbers of areas of needs specified help us with monitoring where we receive grants for specific work.
* Required
Full Name
*
Your answer
Address
Your answer
Post Code
*
Your answer
Telephone Number
Your answer
Email Address
*
Your answer
Age (Optional)
Your answer
Marital Status (Optional)
Married
Divorced
Widowed
Single
Co-habiting
Gender
Female
Male
Other:
Ethnicity
White British
White European
Mixed Race
Asian
Asian British
Black
Black British
Other:
Economic Status (optional)
Paid Work
Self Employed
Voluntary Sector
In Education/Training
Not in Work
Other:
Where you live (optional)
Home Owner
Private Tenant
Social Housing Tenant
Other:
Gender and Age of Child/Children/Young Person with Special Educational Needs or Disabilities
*
Your answer
Please Specify Diagnosis/Area of Need
*
Your answer
What Educational Setting does your Child/Young Person Attend
*
Your answer
Age of any other Child/Young Person
Your answer
Which particular areas of special or additional needs are you interested in? (optional)
Early Years
Physiotherapy
Occupational Therapy
Speech and Language
Health (general)
Education
Preparing for Adulthood
Social care
Other:
Are you a member of any other relevant organisations? (please list) (optional)
Your answer
Have you had any difficulties with any particular service/area of special or additional needs? Please give details (optional)
Your answer
What Time of Day is Best for you to Attend Meetings/Focus Groups/ Workshops (optional)
Morning
Afternoon
Evening
Are you Interested in Becoming a Parent Representative?
*
Yes
No
Would you like to be Involved with Family Voice or kept Informed?
Informed
Involved
Declaration - Please note that by ticking "yes" you are confirming you consent to your details being held in our database, and being kept informed via the details you have provided on the work being conducted by Family Voice, and any upcoming events that you may be interested in. You may withdraw this consent at any time by submitting a request via post to our registered address.
*
YES
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