Child’s / Young Person’s Profile Name of Child / Young Date of Birth: Person: Gender: Age: Primary Language Other used at home: Languages used in the home: Other methods of communication if child / young person is Religion: Ethnicity: Home Address: Young Person’s Young contact no. (if 16yrs Person’s email and over) (if 16yrs and over) Over 16yrs: Does the LA need to consider Mental Capacity Act in relation to this young person? If yes, please give reason. Over 16yrs: Who does young person want involved? Name: Relationship: Contact: Parent / Carer Relationship to Name(s): child / young person: Name of Primary Relationship to Carer: child / young person: Parent / Carer Parent / Carer Telephone no. Email: Does the child / young Yes / No person have a Health Care Plan?
Child’s / Young Person’s Profile Name of Child / Young Person: Date of Birth: Gender: Age: Primary Language used at home: Other Languages used in the home: Other methods of communication if child / young person is Religion: Ethnicity: Home Address: Young Person’s contact no. (if 16yrs and over) Young Person’s email (if 16yrs and over) Over 16yrs: Does the LA need to consider Mental Capacity Act in relation to this young person? If yes, please give reason. Over 16yrs: Who does young person want involved? Name: Relationship: Contact: Parent / Carer Name(s): Relationship to child / young person: Name of Primary Carer: Relationship to child / young person: Parent / Carer Telephone no. Parent / Carer Email: Does the child / young person have a Health Care Plan? Yes / No
sa1_updated_october_2016_uploaded_nov_2017.docx