All information will be treated as confidential. If the family is admitted they will be made aware that we hold this information, who will see it, how it may be used and where it is stored, in line with the provision of the Data Protection Act 2008. Legislation governs how long we are required to keep the information. However if the family is not admitted the information will be destroyed. We expect that the information concerning the family will have been shared with the applicant as part of your procedure in making a referral. If there is any information you do not wish to be shared with the family you must state why. (Please refer to the Data Protection Act) Signatures of Parent/s Date (Required to demonstrate support of the application and knowledge of information provided to St Michael’s Fellowship) COMPLETED APPLICATION TO BE POSTED/EMAILED DIRECTLY TO THE RELEVANT CENTRE or EMAILED TO or faxed to 020 8677 4833 This page is to be completed by parent and returned with Application Form EQUAL OPPORTUNITIES INFORMATION We would be grateful if you could complete this form. The information will be used to assist us in providing you with a better service and will not affect your application in any way. PARENT(S) Single Parent Mother Mother’s Age – Single Parent Father Father’s Age – Couple Do you have a health need or disability which needs special facilities? YES NO If Yes please describe Are you registered disabled? YES NO Please indicate which of the following racial groups you belong to. BLACK Afro-Caribbean European , including UK African Asian please specify Other; please specify Classification recommended by the Commission for Racial Equality PARENT(S) Single Parent Mother Mother’s Age – Single Parent Father Father’s Age – Couple Do you have a health need or disability needs special facilities? YES NO If Yes please describe Are you registered disabled? YES NO Please indicate which of the following racial groups you belong to.
All information will be treated as confidential. If the family is admitted they will be made aware that we hold this information, who will see it, how it may be used and where it is stored, in line with the provision of the Data Protection Act 2008. Legislation governs how long we are required to keep the information. However if the family is not admitted the information will be destroyed. We expect that the information concerning the family will have been shared with the applicant as part of your procedure in making a referral. If there is any information you do not wish to be shared with the family you must state why. (Please refer to the Data Protection Act) Signatures of Parent/s Date (Required to demonstrate support of the application and knowledge of information provided to St Michael’s Fellowship) COMPLETED APPLICATION TO BE POSTED/EMAILED DIRECTLY TO THE RELEVANT CENTRE or EMAILED TO or faxed to 020 8677 4833 This page is to be completed by parent and returned with Application Form EQUAL OPPORTUNITIES INFORMATION We would be grateful if you could complete this form. The information will be used to assist us in providing you with a better service and will not affect your application in any way. PARENT(S) Single Parent – Mother Mother’s Age Single Parent – Father Father’s Age Couple Do you have a health need or disability which needs special facilities? YES NO If Yes please describe Are you registered disabled? YES NO Please indicate which of the following racial groups you belong to. BLACK Afro-Caribbean European , including UK African Asian please specify Other; please specify Classification recommended by the Commission for Racial Equality PARENT(S) Single Parent – Mother Mother’s Age Single Parent – Father Father’s Age Couple Do you have a health need or disability needs special facilities? YES NO If Yes please describe Are you registered disabled? YES NO Please indicate which of the following racial groups you belong to.
Residential%20Assessment%20Referral%20Form%20Aug%202018%20PROTECTED_0.docx