Welcome to Contact Hounslow We offer support with finances, education, understanding diagnoses, transition, short breaks, emotional support and deliver SEND related workshops. To access our services and receive support, please complete the registration form below. If you have any questions or encounter any issues while registering, please don’t hesitate to reach out to us at [email protected] or call us on 020 7608 8765. We’re here to help! "*" indicates required fields Register with a London officeDo you live in the London Borough of Hounslow? Yes No Registration with Hounslow officeAre you a* Parent carer Practitioner completing the form on behalf of a parent carer Contact staff member Important information about data, privacy and consent Before you submit this form, you will need to confirm that the parent carer has consented for their information to be shared with Contact, and held by Contact according to Contact’s privacy policy. The data and privacy statement as well as the confirmation of consent is at the end of this form. Please ensure you have the consent of the parent-carer before completing the form.Contact staff memberContact staff member name Practitioner informationIf you are a practitioner completing this on behalf of a parent carer please complete the belowFirst name* Last name* Email* Enter Email Confirm Email Your organisation* Parent carer – about youFirst name* Last name* Email* Enter Email Confirm Email Phone number* Address Line 1* Address Line 2 Town/City* Postcode* How did you hear about us?* Let us know how you heard about ContactIs English your main language? Yes No Prefer not to say What is your main language?* Do you have a disability / additional needs we need to know about regarding access to service?* Yes No Please let us know more about your disability / additional needsParent carer – more about youPersonal characteristicsProviding information about personal characteristics is voluntary; it will be used to ensure we are reaching people from all communities, and to help us to address the needs of different community groups.What is your gender?Please selectMaleFemalePrefer not to sayPrefer to self describeYour ethnicityPlease selectAsian / Asian UK: BangladeshiAsian / Asian UK: ChineseAsian / Asian UK: IndianAsian / Asian UK: PakistaniAsian / Asian UK: Any other Asian backgroundBlack / African / Caribbean / Black UK: AfricanBlack / African / Caribbean / Black UK: CaribbeanBlack / African / Caribbean / Black UK: Other backgroundMixed / multiple ethnicity: White & AsianMixed / multiple ethnicity: White & Black AfricanMixed / multiple ethnicity: White & Black CaribbeanMixed / multiple ethnicity: Any other originWhite: English / Scottish / Welsh / Northern Irish / UKWhite: IrishWhite: Gypsy or Irish TravellerWhite: Any other White backgroundOther ethnic group: ArabAny Other OriginPrefer not to answerParent carer – about your disabled child(ren) / child(ren) with additional needsPlease enter details of your disabled child (ren) / child(ren) with additional needs. Note: If you have more than 3 children with disabilities / additional needs, please enter the details of the first 3 children below and email information for all other children to [email protected]How many disabled children / children with additional needs do you have?*Please select123More than 3Child 1First name* Last name* Gender*Please selectMaleFemalePrefer not to sayPrefer to self describeDate of birth* Your child's disability / additional needs* Child 2First name* Last name* Gender*Please selectMaleFemalePrefer not to sayPrefer to self describeDate of birth* Your child's disability / additional needs* Child 3First name* Last name* Gender*Please selectMaleFemalePrefer not to sayPrefer to self describeDate of birth* Your child's disability / additional needs* Keep in touchPlease tick how you would like us to stay in contact with you.You must opt into our emails to receive any of our e-newsletters. We might occasionally correspond by phone, SMS or post.By email* Yes No By phone* Yes No By post* Yes No By SMS* Yes No Please note – if you’d like to receive any of our newsletters, please tick “yes” to the “email” option (above).Sign up to our newsletters (sent by email)We’d like to keep in touch with you about our latest news and updates. We will look after your details in accordance with our data protection policy, and we will only ever contact you in the way you want us to. Read more about what you’ll receive if you opt into our updates.What's new – our weekly email newsletter* Yes No Contact’s Hounslow Newsletter – for latest local information and SEND workshops* Yes No Updates on Contact's work and how to support us* Yes No Campaign updates about opportunities to take action on the big issues facing families* Yes No Parent carer – your data and privacyAt Contact we are committed to protecting your privacy. Whenever you share personal data with us we aim to be clear with you, and not to do anything with your data that you wouldn’t reasonably expect us to do. We will never sell your personal data to other organisations and will only ever share it in appropriate, legal or exceptional circumstances. Data may be selected for a random audit by the Advice Quality Standard Assessors. We will only send e-newsletter and marketing communications to those that have explicitly stated that they are happy for us to do so or where we have a legitimate interest reason for doing so. For further information please see contact.org.uk/privacyI agree to my data being processed as outlined above* Yes If you are a practitioner or Contact staff member, completing this form on behalf of a parent carer, please select “yes” to confirm that the parent carer has consented for their information to be shared with Contact, and held by Contact according to their privacy policy.CAPTCHANameThis field is for validation purposes and should be left unchanged.