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Bristol Autism Project Registration Form
About Bristol Autism Project and FACE
FACE (Foundation for Active Community Engagement) is commissioned by Bristol City Council to provide Bristol Autism Project (BAP). Bristol Autism Project is a scheme to provide programmes of activities during the school holidays, Monday - Friday, excluding bank holidays.
Who can join?
Children aged 4-18 who are either: diagnosed as autistic, are awaiting an autism assessment after a referral (on the pathway to diagnosis) or have significant social communication and interaction needs. The autistic child in your family must live in Bristol City Council or be under Bristol Social Care. The entire family register and all siblings may then attend with the autistic child. A parent or trusted adult must attend every activity.
How does it work?
Fill in this Registration Form. Once you are registered you will receive a welcome email or letter. Before every holiday we will email you the programme and expression of interest form. Fill this in. We process the bookings and inform you which activities you have been allocated. Turn up and have fun!
What does Bristol Autism Project do?
At all sessions, Bristol Autism Project staff members are there to offer support and encourage your family to engage with the activity. Many of our sessions are exclusive hire sessions, so there are only Bristol Autism Project families attending. Examples of our activities: adventure playgrounds, sensory room sessions, laser tag, forestry activities, soft play, boat rides, skate parks, cinema, farm visits, Lego, crafts and board games, roller skating, museum visits, bowling, teens only sessions, cooking activities, Gympanzees, horse care experiences, Clip n Climb, sensory play sessions and gymnastics free play sessions, and much more. Outside the holiday times we can also signpost you to other local services. We have a closed Facebook group where members can also reach out to other parents for support.
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Parent/Carer information
Parent/Carer 1 name:
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent/Carer 1 phone number
*
Please enter a valid phone number.
Parent/Carer 1 email address:
*
example@example.com
Parent/Carer 2 OR Emergency Contact
Please provide details of a second parent/carer OR if there is not a second parent carer please put the person you would like us to contact in an emergency.
Parent/Carer 2/ Emergency Contact name:
*
First Name
Last Name
Relationship to child:
*
Please Select
Parent
Carer
Grandparent
Aunt/Uncle
Adult Sibling
Other
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent/Carer 2/Emergency Contact phone number
*
Please enter a valid phone number.
Parent/Carer 2/Emergency Contact email address:
*
example@example.com
Autistic Child information
Child's name:
*
First Name
Last Name
Which of the following applies to your child?
*
Diagnosed as Autistic
Is on the waiting list/pathway for an Autism diagnosis or assessment
Has been identified by a health professional (Speech and Language therapist, Paediatrician, Health Visitor etc.) as having significant social, communication and interaction needs (SCIN)
Child's date of birth
*
-
Day
-
Month
Year
Date
Child's gender
*
Male
Female
Non-binary
Other
Preferred Pronouns
Child's school or type of education e.g. Home Educated, EOTAS
*
Ethnicity
*
Please Select
White - British
White - Irish
White - Gypsy (Including English, Scottish and Roma Gypsy) or Irish Traveller
White - Eastern European
White - Other
Mixed Dual Background - White and Black Caribbean
Mixed Dual Background - White and Black African (non Somali)
Mixed Dual Background - White and Asian
Mixed Dual Background - Other
Asian or Asian British - Indian
Asian or Asian British - Pakistani
Asian or Asian British - Bangladeshi
Asian or Asian British - Chinese
Asian or Asian British - Other
Black or Black British - Caribbean
Black or Black British - African
Black or Black British - Somali
Black or Black British - Other
Other - Arab
Other - Iranian
Other - Kurdish
Other - Iraqi
Other - Turkish
Other
Prefer not to say
Does your child have any allergies or other medical conditions?
*
Yes
No
Please give details of allergies and medical conditions:
Additional Information, please use this space to give any additional information that will help us meet your child's needs at our sessions.
Siblings are welcome to attend Bristol Autism Project sessions. Do you want to add any siblings to your registration?
*
Yes
No
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Sibling Details
Sibling 1 name
*
First Name
Last Name
Sibling 1 date of birth
*
-
Day
-
Month
Year
Date
Child's gender
Male
Female
Non-binary
Other
Preferred Pronouns
Which of the following applies to this sibling?
*
Diagnosed as Autistic
Is on the waiting list/pathway for an Autism diagnosis or assessment
Has been identified by a health professional (Speech and Language therapist, Paediatrician, Health Visitor etc.) as having significant social, communication and interaction needs (SCIN)
None of the above
Ethnicity
*
Please Select
White - British
White - Irish
White - Gypsy (Including English, Scottish and Roma Gypsy) or Irish Traveller
White - Eastern European
White - Other
Mixed Dual Background - White and Black Caribbean
Mixed Dual Background - White and Black African (non Somali)
Mixed Dual Background - White and Asian
Mixed Dual Background - Other
Asian or Asian British - Indian
Asian or Asian British - Pakistani
Asian or Asian British - Bangladeshi
Asian or Asian British - Chinese
Asian or Asian British - Other
Black or Black British - Caribbean
Black or Black British - African
Black or Black British - Somali
Black or Black British - Other
Other - Arab
Other - Iranian
Other - Kurdish
Other - Iraqi
Other - Turkish
Other
Prefer not to say
Does this child have any allergies or other medical conditions? If yes, please give details.
Do you want to add another sibling?
*
Yes
No
Sibling 2 name
*
First Name
Last Name
Sibling 2 date of birth
*
-
Day
-
Month
Year
Date
Sibling's gender
Male
Female
Non-binary
Other
Preferred Pronouns
Which of the following applies to this sibling?
*
Diagnosed as Autistic
Is on the waiting list/pathway for an Autism diagnosis or assessment
Has been identified by a health professional (Speech and Language therapist, Paediatrician, Health Visitor etc.) as having significant social, communication and interaction needs (SCIN)
None of the above
Ethnicity
*
Please Select
White - British
White - Irish
White - Gypsy (Including English, Scottish and Roma Gypsy) or Irish Traveller
White - Eastern European
White - Other
Mixed Dual Background - White and Black Caribbean
Mixed Dual Background - White and Black African (non Somali)
Mixed Dual Background - White and Asian
Mixed Dual Background - Other
Asian or Asian British - Indian
Asian or Asian British - Pakistani
Asian or Asian British - Bangladeshi
Asian or Asian British - Chinese
Asian or Asian British - Other
Black or Black British - Caribbean
Black or Black British - African
Black or Black British - Somali
Black or Black British - Other
Other - Arab
Other - Iranian
Other - Kurdish
Other - Iraqi
Other - Turkish
Other
Prefer not to say
Does this child have any allergies or other medical conditions? If yes, please give details.
Do you want to add another sibling?
*
Yes
No
Sibling 3 name
*
First Name
Last Name
Sibling 3 date of birth
*
-
Day
-
Month
Year
Date
Sibling's gender
Male
Female
Non-binary
Other
Preferred Pronouns
Which of the following applies to this sibling?
*
Diagnosed as Autistic
Is on the waiting list/pathway for an Autism diagnosis or assessment
Has been identified by a health professional (Speech and Language therapist, Paediatrician, Health Visitor etc.) as having significant social, communication and interaction needs (SCIN)
None of the above
Ethnicity
*
Please Select
White - British
White - Irish
White - Gypsy (Including English, Scottish and Roma Gypsy) or Irish Traveller
White - Eastern European
White - Other
Mixed Dual Background - White and Black Caribbean
Mixed Dual Background - White and Black African (non Somali)
Mixed Dual Background - White and Asian
Mixed Dual Background - Other
Asian or Asian British - Indian
Asian or Asian British - Pakistani
Asian or Asian British - Bangladeshi
Asian or Asian British - Chinese
Asian or Asian British - Other
Black or Black British - Caribbean
Black or Black British - African
Black or Black British - Somali
Black or Black British - Other
Other - Arab
Other - Iranian
Other - Kurdish
Other - Iraqi
Other - Turkish
Other
Prefer not to say
Does this child have any allergies or other medical conditions? If yes, please give details.
Do you want to add another sibling?
Yes
No
Sibling 4 name
*
First Name
Last Name
Sibling 4 date of birth
*
-
Day
-
Month
Year
Date
Sibling's gender
Male
Female
Non-binary
Other
Preferred Pronouns
Which of the following applies to this sibling?
*
Diagnosed as Autistic
Is on the waiting list/pathway for an Autism diagnosis or assessment
Has been identified by a health professional (Speech and Language therapist, Paediatrician, Health Visitor etc.) as having significant social, communication and interaction needs (SCIN)
None of the above
Ethnicity
*
Please Select
White - British
White - Irish
White - Gypsy (Including English, Scottish and Roma Gypsy) or Irish Traveller
White - Eastern European
White - Other
Mixed Dual Background - White and Black Caribbean
Mixed Dual Background - White and Black African (non Somali)
Mixed Dual Background - White and Asian
Mixed Dual Background - Other
Asian or Asian British - Indian
Asian or Asian British - Pakistani
Asian or Asian British - Bangladeshi
Asian or Asian British - Chinese
Asian or Asian British - Other
Black or Black British - Caribbean
Black or Black British - African
Black or Black British - Somali
Black or Black British - Other
Other - Arab
Other - Iranian
Other - Kurdish
Other - Iraqi
Other - Turkish
Other
Prefer not to say
Does this child have any allergies or other medical conditions? If yes, please give details.
Do you want to add another sibling?
Yes
No
Sibling 5 name
*
First Name
Last Name
Sibling 5 date of birth
*
-
Day
-
Month
Year
Date
Sibling's gender
Male
Female
Non-binary
Other
Preferred Pronouns
Which of the following applies to this sibling?
*
Diagnosed as Autistic
Is on the waiting list/pathway for an Autism diagnosis or assessment
Has been identified by a health professional (Speech and Language therapist, Paediatrician, Health Visitor etc.) as having significant social, communication and interaction needs (SCIN)
None of the above
Ethnicity
*
Please Select
White - British
White - Irish
White - Gypsy (Including English, Scottish and Roma Gypsy) or Irish Traveller
White - Eastern European
White - Other
Mixed Dual Background - White and Black Caribbean
Mixed Dual Background - White and Black African (non Somali)
Mixed Dual Background - White and Asian
Mixed Dual Background - Other
Asian or Asian British - Indian
Asian or Asian British - Pakistani
Asian or Asian British - Bangladeshi
Asian or Asian British - Chinese
Asian or Asian British - Other
Black or Black British - Caribbean
Black or Black British - African
Black or Black British - Somali
Black or Black British - Other
Other - Arab
Other - Iranian
Other - Kurdish
Other - Iraqi
Other - Turkish
Other
Prefer not to say
Does this child have any allergies or other medical conditions? If yes, please give details.
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FACE terms & conditions and data protection policy:
FACE is a registered charity, and as such is governed by a constitution, board of trustees, and is accountable to the Charity Commission. Please contact the Charity Director or trustee board if you have any queries. The information given on this form is reviewed, added to FACE’s cloud-based database ‘Upshot’ and then held in line with our Data Protection Policy and to comply with GDPR regulations. Please ask us for a copy if you require one. We use this information for statistical monitoring to funders and partners, where individuals are not identified. We also use this information to report to Bristol City Council who funds the contract, where individuals are identified. We may use the information given in this form to contact you in the event of an emergency or if we have a concern we'd like to discuss with you. This information is not passed on to any other organisation or person without your consent, unless we fear a child is at risk of serious harm or we believe a crime has been committed and need to contact the authorities. If you no longer wish for your data to be kept by FACE, please contact us to be anonymised. This will mean all data will be removed and we can no longer contact you.
Bristol City Council GDPR statement:
General Data Protection Regulations as of 25/05/2018: The Local Authority (LA) uses data to carry out specific functions for which it is responsible, such as the assessment of special educational needs and/ or disabilities, home to school transport requirements, admissions, children/ young people’s welfare, children looked after, exclusions and early years support. Anonymised information is used to derive statistics, to inform decisions on (for example) the funding of education settings, to assess educational performance and track Service provision. We will only request and share data with people relevant to statutory duties and individual circumstances. For information regarding data sharing, including retention periods, please visit https://www.bristol.gov.uk/about-our-website/privacyIf you wish to access the personal data held about you or a young person you are responsible for, please contact Bristol City Council in writing: Data Protection Officer, Bristol City Council, PO Box 3399, Bristol, BS1 9NE.Want more information on special educational needs and disability for the under 25s? Visit Bristol’s Local Offer at https://www.bristol.gov.uk/web/bristol-local-offer
Please tick to indicate you have read and agree to the above
*
Yes
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Membership Fee
The membership fee is £39 per year, per family. If any BAP members feel that they are unable to pay the annual membership fee, they can opt-out and do not have to pay the fee and they can still sign-up to holiday activities. On our survey earlier this year, some families wished to have an option to 'pay it forward' for another family. Please select this option if it applies for you.
I agree to pay £39 per year voluntary membership fee
*
Yes, I want to pay by annual direct debit
Yes, I want to pay by monthly direct debit
Yes, I want to pay in person by cash or card at a meet up
Yes, I would also like to pay it forward for another family who cannot pay
No, I want to opt out of paying the voluntary membership fee
Thank you for completing the registration form
Please press submit. You will receive an email confirming we have received your registration form.
Submit
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