solihull.gov.uk

Registration Form for the Children’s Disability Register

* Child's First Name

* Child's Surname

* Child's Date of Birth

* Child's Gender

* Child's Address

* Child's Postcode

* Contact Email Address

* Confirm Email Address

Child's Ethnicity

Child's Current School

* Child's Disability - Please select all those that apply

Further Information

If you would like to provide any additional information to Solihull Council regarding your child's disability please enter information above.

* Your First Name

* Your Surname

Relationship to Child

Contact Telephone Number

Data Protection

Your information may be shared with other council services and partner organisations to ensure our records are kept accurate and to help us to identify services or benefits you may be entitled to or interested in. We may also need to share your information for the prevention and detection of fraud and/or other crimes or as the law requires. For further information about how we use your information please refer to the Council’s Privacy Statement on www.solihull.gov.uk.