Early Years Registration Form
Westbourne Park Family Centre, Westbourne Park Baptist Church, Porchester Road, London W2 5DX
Tel. 020 7727 6019, Charity No. 1085070
Email *
Relation to Child *
Name *
Email
Address *
Postcode *
Which ward do you live in?
Clear selection
Home Tel:
Mobile *
How did you hear about us?
Name of Child *
Name of Second Child
Child's Date of Birth
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Second Child's Date of Birth
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Child's ethnic Background
Child's gender
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Second Child's gender
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Toy Bag Choice - 1 choice for 1 child, 2 choices for 2 children *
Required
Are you a single parent?
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Does your child have a disability?
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Do you have a disability?
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Parent/Carer age
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Parent/Carer first language
Parent/ Carer gender
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Parent/ Carer sexual orientation
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Parent/Carer religion
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As a Charity WPFC receives funding which is given to support families on low income. Do you receive benefits?
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Do you feel financially stressed?
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Data Consent
Westbourne park Family Centre will keep your details secure and not share them with any other organisation without your consent. If you have any questions or want your data changed at any time, contact: info@westbourneparkfamilycentre.org.uk
Do you give permission for these details to be used anonymously as part of an evaluation of our services and their impact?
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We occasionally take photographs for promotion and funding purpose. Do you give us permission to do this
Would you like to receive email updates on upcoming events and opportunities from Westbourne Park Family Centre, Paddington Development Trust and Creative Futures?
Clear selection
Are you interested in volunteering to suport these sessions?
I understand the above statement and agree to the above terms
Print Name *
Date *
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