LCFC Registration Form Step 1 of 5 - Family Address 0% Please fill out this form to register with Lewisham Children and Family Centres. Fields with a red * are required to be filled in.Today's Date* Day Month Year Family Address* Number and Street Address Line 2 Town Post Code Housing Details*Choose from listPermanentTemporaryPrivate RentedHostelHidden Homeless Parent/Carer 1* First Name Last Name PhoneEmail Relationship to Child* How would you describe your gender?* Date of Birth* Day Month Year Ethnicity Disability/Additional Need: Please selectNoneDiagnosed with Autism/Asperger SyndromeBehaviourCommunicationConsciousnessOther DDADowns SyndromeHand FunctionHearingINC: IncontinenceLD: LearningMental HealthMobilityPersonal CareVisionUnknownReligion: Please selectNo ReligionNo DisclosedAnglicanBaptistBuddhistChristianChristian EcumenicalChurch of EnglandCongregationalFree ChurchGreek OrthodoxHinduJehovah’s WitnessJewishMethodistMuslimQuakerRastafarianRoman CatholicRussian OrthodoxSalvation ArmySeventh Day AdventistSikhOther FaithAre you in employment? please selectYesNoAre you registered with a GP? Please selectYesNoAre you pregnant? please select*YesNoIf Yes what is the due date MM slash DD slash YYYY Are you a lone parent? please selectYesNoWhat language is spoken at home? Parent/Carer 2: Please proceed to the next page if not applicable First Name Last Name PhoneEmail Relationship to Child GenderFemaleMaleDate of Birth MM slash DD slash YYYY Ethnicity Disability/Additional Need: Please selectNoneDiagnosed with Autism/Asperger SyndromeBehaviourCommunicationConsciousnessOther DDADowns SyndromeHand FunctionHearingINC: IncontinenceLD: LearningMental HealthMobilityPersonal CareVisionUnknownReligion: Please selectNo ReligionNo DisclosedAnglicanBaptistBuddhistCristianChristian EcumenicalChurch of EnglandCongregationalFree ChurchGreek OrthodoxHinduJehovah’s WitnessJewishMethodistMuslimQuakerRastafarianRoman CatholicRussian OrthodoxSalvation ArmySeventh Day AdventistSikhOther FaithAre you in employment? please selectYesNoAre you registered with a GP? Please selectYesNoAre you pregnant? please selectYesNoIf Yes what is the due date MM slash DD slash YYYY Child Details: Click + button to add extra children*First NameLast NameNHS NumberDate of BirthMale/FemaleEthnicityCurrent Nursery/SchoolRegistered with a Dentist Yes/NoDisability (please state) Here 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 data is stored on a secure database controlled by the London Borough of Lewisham for the purposes of monitoring, evaluation and for the provision of Lewisham Children and Young People’s Partnership services, without consent no service can be provided. 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. Consent* 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. Consent* 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. ContactI 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 Signature - Please type in your name* PhoneThis field is for validation purposes and should be left unchanged.