Parent Request Form Step 1 of 7 - Family Address 0% Lewisham Children and Family Centres run a range of programmes to support children of all ages and their families across the borough of Lewisham. Please complete this request form if you wish to access any of our support services.Family Address* Number and Street Address Line 2 Town Post Code Phone*Email Parent\Carer 1* First Name Last Name How would you describe your gender? Date of Birth Day Month Year Relationship to Child* Is your child on a Child Protection or Children in Need Plan? Please select*NoCPPCINEthnicity Religion: Please selectNo ReligionNo DisclosedAnglicanBaptistBuddhistCristianChristian EcumenicalChurch of EnglandCongregationalFree ChurchGreek OrthodoxHinduJehovah’s WitnessJewishMethodistMuslimQuakerRastafarianRoman CatholicRussian OrthodoxSalvation ArmySeventh Day AdventistSikhOther Faith Parent\Carer 2: If not applicable go to next section First Name Last Name How would you describe your gender? Relationship to Child Date of Birth Day Month Year Ethnicity Religion: Please selectNo ReligionNo DisclosedAnglicanBaptistBuddhistCristianChristian EcumenicalChurch of EnglandCongregationalFree ChurchGreek OrthodoxHinduJehovah’s WitnessJewishMethodistMuslimQuakerRastafarianRoman CatholicRussian OrthodoxSalvation ArmySeventh Day AdventistSikhOther Faith Child Details: Click + button to add extra children*First NameLast NameMale/FemaleDate of BirthSchoolEthnicityNHS Number What are the current worries for you with your child/children?*Can you tell us what support you think you need or what you hope we may be able to help you with?*Have you had any other support with your child/family? (what support service was this?) Did it help?*Have you or your children experienced or witnessed any harmful behaviour previously or currently? If yes, please can you tell us if you or the child/children had any support with this?*Do any of the family members have a special need, physical disability or mental health needs? If yes, please detail below:* Professionals currently Working with your family. GP Health Visitor Social Worker GP surgery and telephone number Health Visitor name and telephone number Social Worker name and telephone number Please tell us the name and telephone of any other agency working with your family. SECTION C FAIR PROCESSING AND CONSENT FORMHere at Lewisham Children and Family Centres we take your privacy very seriously with your consent we will process, retain and store your personal data on behalf of the London Borough of Lewisham in line with the General Data Protection Regulation (GDPR) (EU) 2016/679. Your personal data and contact details will not be shared with any other third party or organisation but may be shared with other Children and Family Centres, and other partnership organisations. You have the following rights regarding your personal data: The right to withdraw consent at any time. The right to request your personal data is deleted. The right to access to your personal data. For more information regarding the use of your personal data please see www.lewishamcfc.org.uk or make a request to: Lewisham.Secure@pre-school.org.uk or Pre-school Learning Alliance, Camelot Centre, 50 Meliot Road, London, SE6 1RY and a copy of the policy will be sent to you. I consent to the following* I understand that by providing my consent I am confirming I understand how and why my personal data is used and give permission for Lewisham Children and Family Centres to store and update my personal details. I consent to the following* I am a parent/legal guardian of a child/children under the age 16 and give consent for Lewisham and Children Family Centres to store and use my child/children’s personal data for the purposes of the service. I give permission to Lewisham Children and Family Centres and any relevant partner organisation to contact me regarding services available and my access to them by the following:* Telephone (including text messages) Email Post PhoneThis field is for validation purposes and should be left unchanged.