Parent/Carer Name *

First Name

Last Name

Do you have children who are eligible for two year old funding? (childcare funding)

Yes

No

Not Sure

Are your children eligible for free school meals?

Yes

No

Not Sure

Are you on a Child Protection Plan?

Yes

No

Are you responsible for Looked After Children?

Yes

No

Do you have a Family Early Help Assessment or have one under development?

Yes

No

I confirm that the information contained in this form is accurate and wish to secure a place on this course. *

I Agree

By ticking I agree you consent that the information requested on this form may be shared within City of York Council and those agencies delivering services in partnership with the Council. *

I Agree

I give consent for Brightsparks to contact me via

Email

SMS

Phone

Post