Does your child require home adjustments or specialist equipment in Yes : No: order to access education or leisure? (Please specify the detail?) Yes : No: Does your child have a general learning disability? If so is there a formal diagnosis? (Specify detail, when diagnosed and by whom) Does your child has a specific learning disability? If so is there a Yes : No: formal diagnosis? (Specify detail, when diagnosed and by whom) Does your child have a behavioural or mental health difficulty? If so Yes : No: is there a formal diagnosis? What is the impact on your child? (Specify detail, when diagnosed and by whom) Has your child been known to Children’s Services either in this Yes : No: borough or elsewhere? (Please share details) Has your child or family ever received support from a Prevention Yes : No: and Early Help Service/Family Support Service in this borough or elsewhere? (Please share details) Does your child engage with any services from charities or the Local Yes : No: Offer which help your child to access play/leisure or education? Are there any additional worries that are impacting on your family? Yes : No: (Adult health, housing, family functioning, income issues)
Does your child require home adjustments or specialist equipment in order to access education or leisure? (Please specify the detail?) Yes : No: Does your child have a general learning disability? If so is there a formal diagnosis? (Specify detail, when diagnosed and by whom) Yes : No: Does your child has a specific learning disability? If so is there a formal diagnosis? (Specify detail, when diagnosed and by whom) Yes : No: Does your child have a behavioural or mental health difficulty? If so is there a formal diagnosis? What is the impact on your child? (Specify detail, when diagnosed and by whom) Yes : No: Has your child been known to Children’s Services either in this borough or elsewhere? (Please share details) Yes : No: Has your child or family ever received support from a Prevention and Early Help Service/Family Support Service in this borough or elsewhere? (Please share details) Yes : No: Does your child engage with any services from charities or the Local Offer which help your child to access play/leisure or education? Yes : No: Are there any additional worries that are impacting on your family? (Adult health, housing, family functioning, income issues) Yes : No:
181016_-_Updated_Amended_AR1_Form.docx