Parent/Carer Membership

If you are a parent / carer of a child or young person up to 25 years of age, and would like to become a member of Rochdale Parent Carers Voice please fill in the form below:

Parent/Carer Newsletter & Member sign up

First Name *

Last Name *

I care for a child/young person (up to age 25) with additional needs or disabilities OR have a child with special educational needs or disabilities (SEND) attending school in the Rochdale area (includes Heywood, Middleton and Pennine). *

Yes

Home Phone Number

Mobile Phone Number *

Email Address *

Address *

Postcode *

Other

PLEASE READ THE ROCHDALE PARENT CARERS VOICE PRIVACY NOTICE ON OUR WEBSITE WHICH EXPLAINS HOW WE DEAL WITH YOUR INFORMATION

Please tick to state you have read and understood the Rochdale Parent Carers Voice Privacy Notice. By becoming a member you consent to your personal data being collected and used as stated in the Privacy Notice

Yes

Date

Would you like to complete our Diversity Monitoring Form? *

Yes

The following diversity monitoring form is used to show we engage with a wide range of families. You do not have to complete the form if you do not wish to. The diversity monitoring form will be separated from your membership form and the information on the monitoring form will be pooled to provide information such as the percentage of members who are foster carers, the percentage of members who are single parents.

Are you?

Female

Male

Do you consider yourself to have a disability?

Yes

Which of the following best describes your ethnic background?

I would rather not say

White

British

Irish

Other White background

Asian or Asian British

Mixed

White and Black Caribbean

White and Black African

White and Asian

Other Mixed background

Black or Black British

Caribbean

African

Other Black background

Any not covered above:

Do you belong to any of the following groups? (tick all that apply)

Foster carer

Adoptive parent

Grandparent with parental responsibility

Single parent

Home educated child

English not first language

Low income family, defined as entitled to claim income related benefits

LGBT parent

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