Name Local Authority Phone Number Email Address Work Address Child/young person status If the child young person is Looked After, under which section of the Children Act 1989 A3 SCHOOL INFORMATION – School Name and Address* Unique Pupil Number* A4 PARENT AND CARER INFORMATION – Contact information for parent/carer (at least one needed) Title First Name* Family Name* Same address as the child or young person?* If Yes, go to If No, please the address Address * Mobile Phone Daytime Phone Number* Number* Home Phone Email Address* Number* Relationship to child or young person? * If Other, please specify Does this person have parental responsibility1 for the child named above? *
Name Local Authority Phone Number Email Address Work Address Child/young person status If the child young person is Looked After, under which section of the Children Act 1989 A3 – SCHOOL INFORMATION School Name and Address* Unique Pupil Number* A4 – PARENT AND CARER INFORMATION Contact information for parent/carer (at least one needed) Title First Name* Family Name* Same address as the child or young person?* If Yes, go to If No, please the address Address * Mobile Phone Number* Daytime Phone Number* Home Phone Number* Email Address* Relationship to child or young person? * If Other, please specify Does this person have parental responsibility1 for the child named above? *
secondary-information-gathering-form-september-2018.docx