Please describe any difficulties that your child has with listening, responsiveness, understanding what you have said or following instructions.
PLAY AND IMAGINATION
How was your child delivered and whether they required any after birth care?
MENTAL AND EMOTIONAL WELL-BEING
SERVICE REQUST FORM
DATA PRIVACY AND INFORMATION SHARING STATEMENT
I confirm that following discussion with school/setting staff, I agree to the involvement of Children’s Services.
I have had the reasons for this service request explained to me, I understand the reasons for the request and understand that my information will be shared with Children’s Services as part of this request. I agree to the request and give consent for Children’s Services to work with my child (or me as the named young person).
I understand that working with my child (or me) will necessitate the sharing of information between relevant services, in the interests of providing a service to me or my child. I understand that the information contained within this form will be recorded on a Hertfordshire County Council case management system and other services may be able to see the content on this form. Hertfordshire County Council is the Data Controller for this information and its lawful basis for processing is tofulfil its duties in respect of special educational needs provision (public task).
Information on you or your child/young person will be held until 35 years after the date of birth.
Full information on your rights in respect of personal data held about you can be found at https://www.hertfordshire.gov.uk/about-the-council/legal/privacy-policy/privacy-policy.aspx
Strengths and Difficulties Questionnaire
For each item, please mark the box for Not True, Somewhat True or Certainly True. It would help us if you answered all items as best you can even if you are not absolutely certain or the item seems daft!