Parent / Carers Registration Form To make sure you get the best possible service and support from your children’s centre we would like to know some information about you and your family. Please complete all sections of this short form. It should take no more than 5 minutes of your time. Once you have completed it and are registered with Reading Children’s Centres, you will be able to access all our fantastic free services and support on offer.Main parent/carer & correspondentYour name (parent/carer)* First Last Address* Street Address Address Line 2 City County Postcode Phone*Email address* Date of birth Date Format: DD dash MM dash YYYY Ethnicity (please select from the drop down list)BangladeshiIndianAny Other Asian BackgroundAny Other Black BackgroundAny other Ethnic BackgroundAny Other Mixed BackgroundBlack-AfricanBlack-CaribbeanChineseGypsy/Roma HeritageInformation Not yet ObtainedPakistaniRefusedTraveller of Irish HeritageWhite & AsianWhite & Black AfricanWhite & Black CaribbeanWhite BritishWhite IrishPregnant? Pregnant Due date Date Format: DD dash MM dash YYYY All children under 5 years in your household (youngest child first)Youngest child's name* First Last Date of birth* Date Format: DD dash MM dash YYYY Gender*MaleFemaleEthnicity (please select from the drop down list)BangladeshiIndianAny Other Asian BackgroundAny Other Black BackgroundAny other Ethnic BackgroundAny Other Mixed BackgroundBlack-AfricanBlack-CaribbeanChineseGypsy/Roma HeritageInformation Not yet ObtainedPakistaniRefusedTraveller of Irish HeritageWhite & AsianWhite & Black AfricanWhite & Black CaribbeanWhite BritishWhite IrishNext child's name First Last Date of birth Date Format: DD dash MM dash YYYY GenderMaleFemaleEthnicity (please select from the drop down list)BangladeshiIndianAny Other Asian BackgroundAny Other Black BackgroundAny other Ethnic BackgroundAny Other Mixed BackgroundBlack-AfricanBlack-CaribbeanChineseGypsy/Roma HeritageInformation Not yet ObtainedPakistaniRefusedTraveller of Irish HeritageWhite & AsianWhite & Black AfricanWhite & Black CaribbeanWhite BritishWhite IrishOldest child's name First Last Date of birth Date Format: DD dash MM dash YYYY GenderMaleFemaleEthnicity (please select from the drop down list)BangladeshiIndianAny Other Asian BackgroundAny Other Black BackgroundAny other Ethnic BackgroundAny Other Mixed BackgroundBlack-AfricanBlack-CaribbeanChineseGypsy/Roma HeritageInformation Not yet ObtainedPakistaniRefusedTraveller of Irish HeritageWhite & AsianWhite & Black AfricanWhite & Black CaribbeanWhite BritishWhite IrishDeclarationBy submitting this form I declare that all information I have provided to Reading Children’s Centres is true to my knowledge. I understand that information provided will be kept on file (including the children’s centres computer system), to ensure that I receive relevant information, and for the children’s centres statistical monitoring and evaluation purposes. I understand that any information regarding myself and my family will be kept confidential and will not be passed to organisations outside of the children’s centres partners without my consent, unless it is of a child protection nature, in which case I understand that information will be shared only as may be necessary and only with appropriate agencies. I understand that Reading Children’s Centres undertakes to keep all information provided in a secure location. I also agree for additional information relating to family changes to be updated by professionals working alongside the children’s centres. I retain the right for these records to be deleted upon request. We may contact you by phone, email, text using the details you have provided. If you wish to opt-out of being contacted by Reading Children’s Centres please email us on reading.childrenscentres@brighterfuturesforchildren.orgYour full name* First Last Name First Last Name First Last
