Registration Form

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Contact Details

I am a*
Parent/CarerProfessional

First name*

Last name*

Address 1*

Address 2*

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Email address*

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Landline number

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Your Date of Birth

How many children do you have?*
—Please choose an option—012345678910

How many children do you have with special educational needs or disability*
—Please choose an option—012345678910

Are you a person living with a disability?*
—Please choose an option—YesNoPrefer not to say

Gender*
—Please choose an option—MaleFemaleOther preferred descriptionPrefer not to say

Ethnicity*
—Please choose an option—BangladeshiChineseIndianPakistaniAny other Asian backgroundAfricanCaribbeanAny other Black backgroundWhite and AsianWhite and Black AfricanWhite and Black CaribbeanAny other Mixed/Multiple ethnic backgroundWhite British (English/Welsh/Northern Ireland/Scotland)White IrishWhite Gypsy or Irish TravellerRomaAny other white backgroundArabAny other ethnic groupPrefer not to say

Nationality*
—Please choose an option—BritishAfghanAlbanianAlgerianAmericanAndorranAngolanAntiguansArgentineanArmenianAustralianAustrianAzerbaijaniBahamianBahrainiBangladeshiBarbadianBarbudansBatswanaBelarusianBelgianBelizeanBenineseBhutaneseBolivianBosnianBrazilianBruneianBulgarianBurkinabeBurmeseBurundianCambodianCameroonianCanadianCape VerdeanCentral AfricanChadianChileanChineseColombianComoranCongoleseCosta RicanCroatianCubanCypriotCzechDanishDjiboutiDominicanDutchEast TimoreseEcuadoreanEgyptianEmirianEquatorial GuineanEritreanEstonianEthiopianFijianFilipinoFinnishFrenchGaboneseGambianGeorgianGermanGhanaianGreekGrenadianGuatemalanGuinea-BissauanGuineanGuyaneseHaitianHerzegovinianHonduranHungarianI-KiribatiIcelanderIndianIndonesianIranianIraqiIrishIsraeliItalianIvorianJamaicanJapaneseJordanianKazakhstaniKenyanKittian and NevisianKuwaitiKyrgyzLaotianLatvianLebaneseLiberianLibyanLiechtensteinerLithuanianLuxembourgerMacedonianMalagasyMalawianMalaysianMaldivanMalianMalteseMarshalleseMauritanianMauritianMexicanMicronesianMoldovanMonacanMongolianMoroccanMosothoMotswanaMozambicanNamibianNauruanNepaleseNetherlanderNew ZealanderNi-VanuatuNicaraguanNigerianNigerienNorth KoreanNorthern IrishNorwegianOmaniPakistaniPalauanPanamanianPapua New GuineanParaguayanPeruvianPolishPortugueseQatariRomanianRussianRwandanSaint LucianSalvadoranSamoanSan MarineseSao TomeanSaudiScottishSenegaleseSerbianSeychelloisSierra LeoneanSingaporeanSlovakianSolomon IslanderSomaliSouth AfricanSouth KoreanSpanishSri LankanSudaneseSurinamerSwaziSwedishSwissSyrianTaiwaneseTajikTanzanianThaiTogoleseTonganTrinidadian or TobagonianTunisianTurkishTuvaluanUgandanUkrainianUruguayanUzbekistaniVenezuelanVietnameseWelshYemeniteZambianZimbabweanAny other NationalityPrefer not to say

Organisations

If you are registering as a professional from an organisation working with children with special educational needs and/or disability - please complete the section below.

Organisation

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Areas of interest

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Please Note: In becoming a member you agree to the following:

• Your details will be entered into the Leeds Parent Carer Forum's confidential database and used by the forum to communicate with you, including our email newsletter, which you can unsubscribe from at any point.

• Your information will be held securely and not shared with any other organisations as per requirements of General Data Protection Regulations (GDPR).

• We will keep you informed about participation opportunities and invite you to contribute your views.

Please tick to say you have read and agree to the above*
I give permission for any photographs that are taken of me and/or my family at any Leeds Parent Carer Forum events and activities to be used by Leeds Parent Carer Forum for fundraising and publicity purposes