The Southend Family Network
Joint Registration and Consent Form

Please complete this form to register to access services for children and families in Southend

Special Category Data

The information requested in Bold and Underlined on this form is special category data under data protection legislation. Giving us the information in these boxes is optional but having it will help us provide the best service to you and other parents. There will be no penalty if you don’t want to give us the information.

We require your consent to process and store this type of information about you. If you have provided some or all of the information in the yellow boxes, please confirm your consent in the box provided at the end of this form.

Section A – PARENT/GRANDPARENT/LEGAL GUARDIAN

Family Name

Mother surname

Family Member Details

Title

First Name

Last Name

Date of birth

Family Member Type

Mobile Phone

Home Phone

Do you have parental responsibility?

Gender

Ethnic origin [HL]

Are you or your partner pregnant?

If yes, please state expected due date

Do you have a disability?

Do you have any additional needs?

Disabilities/difficulties/additional needs

What is the main language used at home

Address 1

Address 2

Town or city

Country

Post Code

Consent to Contact

We would like to use the information you have provided to contact you about future events, news and services that we offer. We would also like to contact you so you can join the YourFamily Community.

If you are happy to be contacted, please tell us your preferences -

I consent to:

Southend Family Centres

A Better Start Southend

YourFamily

Phone

Text

Post

You can withdraw your consent at any time, if you would like to know more about joining the YourFamily Community or how to withdraw your consent please see our Privacy Notice for these details.

SECTION B - CHILD’S DETAILS

Please complete for all children aged 16 and under

Child First Name

Child Surname

Your relationship to child

Child Date of Birth

Child Gender

Child Disabilities/difficulties or additional needs

Child Ethnic origin

What is the main language used at home

Child live in the same address as Adult?

Child Address 1

Child Address 2

Child Town or City

Child Country

Child Postcode

Emergency Contact Details for your Child/ren (other than yourself)

Name

Contact Number

Relationship to child

DATA PROTECTION - PRIVACY NOTICE

Who we are:

The Southend Family Network is a partnership of two organisations:

Early Years Alliance (Trading as A Better Start Southend)

Southend-on-Sea City Council

Charity #1096526

The Southend Family Network are registered with the Information Commissioner and act jointly, as data controllers, to protect your data in accordance with the Data Protection Act 2018, The UK GDPR, our Joint Controller Agreement and any other appropriate regulations.

The information we collect from you will be used to register you and your child for our services. The processing of your information allows us to deliver our services to you. If you have consented to receiving information about our future events, activities, news and services, then we will also reach out to you for this reason. If you would like to change or withdraw your consent, please let us know at familycentres@southend.gov.uk.

As our projects are often funded by external organisations such as National Lottery Community Fund, Department for Education and research groups, we may share your personal details with them, as they have an interest in the success and performance of our services. This also helps us give our Funders a better understanding of who we are reaching with our services and where we may need to improve to ensure the community is reflected in those using our services. We may link your personal information with other data collected by our partners (for example data on Education and Health) to ensure our services are making a difference. Whenever we share your personal information, we ensure it is protected.

If you would like more information on how we process your data please request a full privacy notice from your local family centre, or send us an email at familycentres@southend.gov.uk or absscontracts@eyalliance.org.uk

You can view our individual privacy notices here:

https://abetterstartsouthend.co.uk/privacy/

https://www.eyalliance.org.uk/privacy-policy

Consent

Special Category Data

If you have provided some or all of the information which is Bold and Underlined,

please indicate your consent to us using the information (as explained at the start of this form).

I consent to The Southend Family Network processing the Special Category Data provided by me and my Family

I have read the Privacy Notice and understood how my information will be used

Contact Information