Children's Disability Record Registration Form

  • Information about your child
  • Name
  • Gender
  • Information about parent/carers
    Information will be sent to the first named parent/carer. Where an email address is provided, information will be sent electronically.
  • Name of parent/carer 1
  • Are you a lone carer?
  • Name of parent/carer 2
  • Would you like information about services for carers?
  • Would you like information about benefits?
  • Benefits
  • Are you receiving Disability Living Allowance for your child, or are they receiving it in their own right?
  • If yes, which rate do you receive for the mobility component?
  • Which rate do you receive for the care component?
  • Your child’s needs
  • How do you consider the disability to be?
  • Equipment
  • Does your child have any special equipment at home?
  • Does your child have any special equipment at school?
  • Education
  • A child does not need to have a statement of special educational needs to be on the Children’s Disability Register.
  • Self-help skills
    Please indicate your child’s ability to manage the following tasks, compared to a child of a similar age without a disability.
  • Does the adult with primary responsibility for care in your household get a complete night’s sleep?
  • Does your child have short break care?
  • Does your child have trained carers?
  • Communication
  • Is English your child’s first or preferred language?
  • Does your child use or understand a signing system or sign language?
  • Is your child an independent communicator?
  • Consent for Registration
  • Please confirm you are the parent or carer?
  • Do we have your permission to hold the details provided on this form in accordance with the Data Protection Act 1998?
  • Do you agree to your child’s name being included in the Trafford Children’s Disability Register?
  • The information is recorded to help with the planning of services for children with disabilities. I understand that in order to determine the best possible services for my child, information may be supplied and/or used by Trafford’s Children and Young People Services.
  • Name