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Early Years Inclusion Team Parent / Guardian ConsentA parent or guardian with parental responsibility must complete and sign the ‘Consent’ section.Consent for: (tick box)EYITPortageSeedlingsEIAEIA ContinuationChild’s full nameDate of BirthGenderEthnicity (tick box)WBRI (White British)WRI (White, Irish)WIrt (Traveller of Irish Heritage)WROM (Gypsy / Roma)WOTH (White, any other White background)MWBC (Mixed, White and Black Caribbean)MWBA (Mixed, White and Black African)MWAS (Mixed White and Asian)MOTH (Mixed, any other mixed background)AIND (Asian or Asian British, Indian)APKN (Asian or Asian British, Pakistan)ABAN (Asian or Asian British, Bangladeshi)AOTH (Asian or Asian British, any other Asian background)BCRB (Black or Black British Caribbean)BAFR (Black or Black Brisith African)BOTH (Black or Black British, any other Black Background)CHNE (Chinese)OOTH (Any other ethnic background)REFU (Did not wish to be recorded)NOBT (Not obtained)Address including PostcodeContact telephone numberEmail addressName of person (s) with parental responsibilityContact details if different from aboveAddressContact telephone numberIs the child a “Child looked after” Yes / NoIf Yes:Local Authority ResponsibleName of Social WorkerContact details: including address and telephone numberAgencies / Services involvedContact NameI do / I do not consent to information being shared with Agencies / Services(indicate accordingly Yes / No)General Development Assessment (GDA)Yes / NoAutism Assessment Pathway (ASAP)Yes / NoService for children withHearing ImpairmentYes / NoService for children with Visual ImpairmentYes / NoSAID SEND ServiceYes / NoASCETSYes / NoG.P.Yes / NoFamily HubsYes / NoSpeech & LanguageYes / NoPhysiotherapyYes / NoOccupational TherapyYes / NoSocial CareYes / NoEducational Psychology ServiceYes / NoHealth VisitorYes / NoSpecial Educational Needs TeamYes / NoOtherYes / NoHas an Early Help Assessment been completed?Yes / NoDate commencedIf ‘Yes’ please indicateName of Lead ProfessionalPositionContact telephone numberEmail addressPrivacy Notice – Early Years Requests:This Privacy Notice sets out what you need to know about how Doncaster Council will use your information for the Early Years Requests.Doncaster Council is committed to meeting its data protection obligations and handling your information rmation required for Early Years Request (or information required to enter into an agreement)You are required to provide us with your information to receive the service.The consequences of not providing the information required is that your Request cannot be processed.Please ensure you read and understand this notice before submitting information to us.Why the data is collected and how it will be used:Your information is collected and used to inform:An Early Years Request outcome.Allocation of Early Intervention Allowance funding.Service data (this provides information in relation to allocation of funding, child’s primary need, settings supported by Early Years Inclusion Team etc.) and used to inform Service delivery.Statutory returns.Freedom of information.What information about you do we collect?For the processing to which this notice relates, we use the following information:Personal information (such as your child’s name, date of birth, your name, address, telephone number).Sensitive information (such as your child’s ethnicity, information about your child’s SEND, who has parental consent or ‘Child looked after’.How do we collect information about you?Directly as a Provider through completion of an Early Years Request form.At an APDR meeting (Assess, Plan, Do, Review) by professionals/parent.From the referrer if not collected directly from the subject.Confirmation of InvolvementDoncaster Metropolitan Borough Council (DMBC) is committed to working with Early Years providers to improve outcomes for children in Doncaster. Working in partnership with parents / carers and other professionals, we want to ensure that children in Doncaster have the very best start in life.Doncaster Council is registered as a Data Controller and Data Processor under the Data Protection Act as we collect and process personal information about you.We will process your information for the purposes of offering support from the Early Years Inclusion Team and to monitor and improve the council’s performance in responding to your request.We will also process your information to allow us to be able to communicate ad provide services and benefits appropriate to your needs, and to ensure that we meet our legal obligations.We will not disclose any information that you provide ‘in confidence’ to us, to anyone else without your permission, except in the few situations where disclosure is required by law, or where we have good reason to believe that failing to share the information would put someone else at risk.We may disclose information to other partners where it is necessary, either to comply with a legal obligation, or where permitted under the Data Protection Act and the upcoming General Data Protection Regulation (GDPR) e.g., where the disclosure is necessary for the purposes of the prevention and/or detection of crime.At no time will your information be passed to organisations external to the Doncaster Council for marketing or sales purposes, or for any commercial use without your prior express consent.Parental Consent:I give permission for the Early Years Inclusion Team service to seek information from other professionals who may have relevant information about my child and to store, process and share information with appropriate professionals in compliance with Data Protection laws.I also give permission for members of Early Years Inclusion Team service to work with my child, individually or in a group, and that I have the right to be present at any individual session if I wish. I understand that I can withdraw part, or all, of this consent by writing to the Early Years Inclusion Team service at any time.If you have any questions about the collection of your information, what rights you have, or wish to complain about the use of your information, please contactNikki Minnikin, Data Sharing and Protection Officer – dataprotection@.uk or Civic Office, Waterdale, Doncaster, DN1 3BU.Please sign and date to confirm you have ready the Privacy NoticeSignature ………………………………….Date ………………………………………..Name of person signingRelationship to childConsent signatureDatePlease email to: EarlyYearsRequest@.ukor return to:Early Years Inclusion TeamFloor 3The Civic BuildingWaterdaleDoncasterDN1 3BUEarly Years Inclusion Team - Partnerships and Operational DeliveryDoncaster Metropolitan Borough CouncilThe Civic Building, Floor 3, Civic Quarter, Waterdale, Doncaster, DN1 3BU ................
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