AAPS-UK CIC Registration Form

AAPS-UK CIC Registration Form

Please use this form to register for our projects and services. This helps us get to know you better and how we can best support you and keep you safe. As well as helps us meet the needs of our funders. If you require any support completing this form please do let us know via contact@aaps-uk.org
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone number *
Email *
example@example.com
Birth Month (MM)*
Year of Birth (YY)*
Gender*
What project or service are your registering for?
Monday Parent Support Group - Swanley KentAllotment Gardening Club - SwanleyFriday Parent Support Group - West Kingsdown
Please state the first name(s) and age(s) of any children attending with you?*
Do you (or your children, if attending) have any allergies or medical conditions we need to know about that may affect your safety?*
WhiteMixedAsian / British AsianBlack / Black BritishPrefer not to sayOther
NoPhysical DisabilityMental Health ConditionLong Term Health ConditionSensory ImpairmentLearning DisabilityPrefer not to sayOther
Emergency Contact Number*
Emergency Contact Name*
Emergency Contact - Relationship*
Word of MouthFlyer / LeafletSocial MediaBrowser Search (eg Google)WebsiteReferral from another organisationOther
YesNo
YesNo
Yes pleaseNo thank you
Here at Autism & ADHD Parent Support UK CIC, we take the safety and confidentiality of your information very seriously, which will only be used for our own record keeping purposes. Information will not be passed on to third parties in accordance with the GDPR Act 2018. Please indicate below whether you consent to us contacting you via email. so we can keep you up-to-date about other future projects/services we have.*

I am happy to receive email updates from Autism & ADHD Parent Support UK CICI DO NOT wish to receive email updates from Autism & ADHD Parent Support UK CIC
In order to help us to continue to improve our services, monitor their impact and provide feedback of our projects to our funders, it would be really helpful if you could complete the pre-project survey below. Thank you for taking the time to do so.
How well supported do you feel as a SEND parent?*

1

2

3

4

5

1 is Not at all, 5 is Fully supported
Does being a SEND parent affect your own personal wellbeing or mental health?*

1

2

3

4

5

1 is Not at all, 5 is It affects me greatly
Is there any other information / feedback you would like to share with us?*
Should be Empty: