Play Plus Enrolment and Needs assessment form

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The Big Red Bus Club works to provide a range of services to support families and their health and wellbeing. We are asking Play Plus participants to fill this document in so we can understand better you and your families' needs. Responses are anonymous and will be used in planning services and for designing and developing future projects at the Big Red Bus Club.

For more information on how we use and store data at please see our website https://www.thebigredbusclub.com/privacy

Play Plus is kindly funded by Children in Need

Company registration number 08132170
Registered charity, England and Wales. 1170704

Email *

Name of parent who will be attending?

First name of the child that will be attending?

Last name of child who will be attending?

Are you or any of your family from a Black Asian or minority ethnic group

Yes

Clear selection

How many children under 5 do you have?

Do any of your children have a disability, long term health condition or additional needs? This includes SEND or EHCP

Yes

Clear selection

If your child already has a diagnosis of the above or you know please can you give a short description of their needs

Do you feel that any of your children who are under 5 are struggling with certain things that other children are not.

Yes

Maybe

Clear selection

What things are your children who are under 5 struggling with?

Speech and language

Large movement skills like walking, running and jumping

Small movement skills such as gripping and using pencils, picking up and moving around small items

Coping with new situations

Being around other kids

Being around adults they don't know

Other behavioural difficulties

Other:

What are your reasons for coming to Play Plus?

In your own words what if any are your biggest concerns or worries about your child's speech, language and communication or other development

How do you feel your child's speech, language, communication or behaviour is like or different to other children's or their brothers and sisters at a similar age?

What language is used in the home most to talk with children and amongst family members

English

Other:

If a different language is used at home or amongst family members are their difficulties in speech and language in that language as well as in English?

Yes

Maybe

Clear selection

What borough do you live in?

Greenwich

Bexley

Lewisham

Other:

Clear selection

Have you either on zoom or in person seen a speech and language therapist for an assessment?

Yes

Other:

Clear selection

Have you raised your concerns with a health visitor or other professional such as your GP?

Yes

Other:

Clear selection

Are you concerned about any other things with regards to your child?

Do you currently use any form of Makaton or signing at home with your children?

Yes

Clear selection

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