Please complete this form to make contact with our service.

Havering SENDIASS offer a free, impartial, confidential information, advice and support service offering support to young people (16-25) with SEND and parents of children with SEND.

SENDIASS works in partnership with Barnardos who also provide independent support for Havering residents, some cases may be referred to them for independent support. 

Your Name:

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* 1. Your Name:

Your contact telephone number:

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* 2. Your contact telephone number:

Your Email Address:

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* 3. Your Email Address:

Young Person / Child's Name

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* 4. Young Person / Child's Name

Age of young person or child you are contacting us about:

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* 5. Age of young person or child you are contacting us about:

Date of birth of young person or child you are contacting us about:

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* 6. Date of birth of young person or child you are contacting us about:

DOB
Which race/ethnicity best describes your child? (Please choose only one.)

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* 7. Which race/ethnicity best describes your child? (Please choose only one.)

Your relationship to the young person or child:

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* 8. Your relationship to the young person or child:

Nursery, school or college they attend:

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* 9. Nursery, school or college they attend:

Reason for contacting us, please add as much information about your inquiry below.

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* 10. Reason for contacting us, please add as much information about your inquiry below.

CONSENT:

Havering SENDIASS works in partnership with Barnardos who also provide independent support for Havering residents. When staff support you we require your consent to speak to other professionals on your behalf. If you are happy for us to do this, please read the statement and sign below;

I hereby give my consent for Havering SENDIASS to access files held by the Havering Children and Adults with Disabilities Team. Also, where necessary to speak to other professionals to find out more information on my behalf.

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* 11. CONSENT:

Havering SENDIASS works in partnership with Barnardos who also provide independent support for Havering residents. When staff support you we require your consent to speak to other professionals on your behalf. If you are happy for us to do this, please read the statement and sign below;

I hereby give my consent for Havering SENDIASS to access files held by the Havering Children and Adults with Disabilities Team. Also, where necessary to speak to other professionals to find out more information on my behalf.

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