This enquiry for support if for: *

Panoramic Support

Therapeutic Educational Support

Other

Parent/Carer Name *

First Name

Last Name

Phone *

(###)

###

####

Child's Name

First Name

Last Name

Date of birth

MM

DD

YYYY

Ethnicity

Asian or Asian British (Indian Pakistani Bangladeshi Chinese Any other Asian background)

Black, Black British, Caribbean or African (Caribbean AfricaBlack British, or Caribbean background)

Latino/a (from Latin America)

Mixed or multiple ethnic groups (White and Black Caribbean White and Black African White and Asian Any other Mixed or multiple ethnic background)

Prefer not to say

Does your child have an EHCP?

Yes

No

Is your child eligible for pupil premium?

Yes

No

Not sure

Is your child eligible for free school meals?

Yes

No

Not sure

Before submitting this form, please ensure that you have read and agree to Cambridge Acorn Project’s Terms of Service (available at the bottom of this page) *

By ticking yes and submitting this form your are confirming that: • You have parental responsibility • You agree to share the information provided in this form with Cambridge Acorn project and are aware that Cambridge Acorn Project will safely store this information. • This form contains accurate information. • You consent to Cambridge Acorn Project delivering services in response to your enquiry (when applicable) • You agree to Cambridge Acorn Project’s Terms of Service If you do not agree, please do not submit this form.

Yes, I consent

Submission date *

MM

DD

YYYY