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Need to speak to a member of our team? Call us on 0161 711 0339

About us
Support for families
Get involved
Events
Donate
Make a referral

Parent needs application form

Please complete the form below before any assessments are taken place.

Details of the person attending the group session

First name(Required)

Last name(Required)

Email Address(Required)

Phone number(Required)

Address(Required)

Emergency Contact

First name(Required)

Last name(Required)

Email(Required)

Phone(Required)

Address(Required)

Medical Details

GP name(Required)

GP phone number

GP address(Required)

Do you have a disability that you would like to share with us?*(Required)

Yes

No

Please provide details of the disability including any help that you may need.

Do you have any dietary requirements or allergies we need to know about?*(Required)

Yes

No

Please provide more information

Is there any additional information we need to be made aware of, including any fears or questions you may have prior to the group session?

Terms & Agreements

At Once Upon a Smile, we love to share the amazing work our children take part in. Do you agree for your child to participate in photography & videography? This can include the possibility of sharing on our social media platforms.(Required)

Yes, I agree

No, I don’t agree

I agree to the names above being kept on database for tracking and contact purposes.*(Required)

Yes, I agree

No, I don’t agree

Do you give permission to be contacted for feedback or outside of a group session should you need to leave without informing OUAS staff, we do kindly ask you to speak to a member of staff prior to leaving.*(Required)

Yes, I agree

No, I don’t agree

Date of completion(Required)

DD slash MM slash YYYY

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