Breadcrumb Home Registration & Consent Registration & Consent You must have JavaScript enabled to use this form. Registration Parent Name First Name Surname Telephone Email Address Address City/Town ZIP/Postal Code Country - Select -AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua & BarbudaArgentinaArmeniaArubaAscension IslandAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia & HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCanary IslandsCape VerdeCaribbean NetherlandsCayman IslandsCentral African RepublicCeuta & MelillaChadChileChinaChristmas IslandClipperton IslandCocos (Keeling) IslandsColombiaComorosCongo - BrazzavilleCongo - KinshasaCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d’IvoireDenmarkDiego GarciaDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard & McDonald IslandsHondurasHong Kong SAR ChinaHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacao SAR ChinaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmar (Burma)NamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorth KoreaNorth MacedoniaNorwayOmanOutlying OceaniaPakistanPalauPalestinian TerritoriesPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSamoaSan MarinoSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia & South Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSt. BarthélemySt. HelenaSt. Kitts & NevisSt. LuciaSt. MartinSt. Pierre & MiquelonSt. Vincent & GrenadinesSudanSurinameSvalbard & Jan MayenSwedenSwitzerlandSyriaSão Tomé & PríncipeTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad & TobagoTristan da CunhaTunisiaTurkeyTurkmenistanTurks & Caicos IslandsTuvaluU.S. Outlying IslandsU.S. Virgin IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamWallis & FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Activities I'm Registering For If you select a children's activity, fields for the child's details and a parental/carer's consent form will appear below. My Tribe Teens My Tribe Junior My Tiny Tribe Stories with a Twist My Advocacy Partner My Companion Walk and Talk Coffee Connect Wisdom & Wonder The 10 Pages & Podcast Club Speaker Session Parents' Circle Child Details Child Details Child Name First Name Surname Child Date of Birth Child School Child Diagnosis / Suspected Condition(s) Child Additional Information Please provide us with any information that is important for us to understand your child's needs most. eg: Sensitive to noise, likes to run around, will communicate using communication boards, likes to have space, requires social support. Anything that can help us understand your child more. Consent ConsentThe next questions concern consent for your young person to attend the sessions we run. I consent to My child taking part in the activities ran by The Neurodiversity Family Hub C.I.C. The Neurodiversity Family Hub C.I.C. keeping a record of this form for health and safety reasons Any medical treatment that my child may need to be given in an emergency My child being filmed or photographed during the activity, with the possibility that these photographs/media recordings may be used for publications or marketing publicity. will take all steps to ensure these images are used solely for the purposes for which they are intended.) Note: if consent is not given, The Neurodiversity Family Hub C.I.C will not use any images taken during the activity that contain the child/young person I understand that my child needs to follow the behaviour code and any safety rules so that [name of group/organisation] can keep them and other children safe Other Conditions Does your child have any medical conditions (other than a neurodiversity) or allergies that we need to be aware of? If you select 'Yes' we will email you our medical form accordingly. Yes No Emergency Contacts Emergency ContactsPlease provide additional contacts in case you are unavailable in an emergency NB: These must be London based residents, and someone local to our clubs Contact 1 Emergency Contact 1 Name First Name Surname Emergency Contact 1 Telephone Contact 2 Emergency Contact 2 Name First Name Surname Emergency Contact 2 Telephone Leave this field blank join us volunteer donate