Parent Register

Title Mr Mrs Ms Miss Dr Other

Please specify your 'title' below

First & middle names

Surname

Identify my gender as

Nationality

Primary language spoken

Do you speak any other languages? Yes No

Please list other languages

House number & street name

Town or City

County

Postcode

Telephone / Mobile number

Email address

How many children do you need a carer for?

Do you need a driver? Yes No

Can you provide a car? Yes No

Do you require someone with specific experience (e.g. medical, ABA, etc)? Yes No

Please specify the experience you require?

Do you need additional care?

Is there anything we have forgotten to ask you or you would like us to know?

GDPR – I consent to esSENtial ABA Childcare Ltd storing my submitted information in order to send me relevant esSENtial ABA Childcare Ltd child carers to provide childcare services. Yes No

GDPR – I consent to esSENtial ABA Childcare Ltd sharing relevant submitted information (Child's DOB, diagnosis, disabilities, method of communication, medical requirements, and relevant behavior) with esSENtial ABA Childcare Ltd child carers, upon request. (This allows us to share your relevant information with potential child carers that may be working with your child, at their request.) Yes No

esSENtial ABA Childcare is a data controller under the Data Protection Act. We will use the information you provide only in connection with the services provided by esSENtial ABA Childcare. Your details will be stored securely, treated in strictest confidence and will not be passed onto a third party, except with your explicit permission or as to do so by law.