Family Hub membership form

Parent/Carer 1
Title
If other, please state
First name
Surname
Known as
Address
Postcode
Date of birth
Telephone number
Email address
Ethnicity
Lone parent
YesNo
Employment status

Parent/Carer 2
Title
If other, please state
First name
Surname
Known as
Address
Postcode
Date of birth
Telephone number
Email address
Ethnicity
Lone parent
YesNo
Employment status

Child one
First name
Surname
Known by
Address
Postcode
Date of birth
Gender at birth
MaleFemaleNon-binaryPrefer to self-describe
Ethnicity
Additional needs
Who holds parental responsibility?
Do they attend nursery, school or college?
Add another child
YesNo

Child two
First name
Surname
Known by
Address
Postcode
Date of birth
Gender at birth
MaleFemaleNon-binaryPrefer to self-describe
Ethnicity
Additional needs
Who holds parental responsibility?
Do they attend nursery, school or college?
Add another child
YesNo

Child three
First name
Surname
Known by
Address
Postcode
Date of birth
Gender at birth
MaleFemaleNon-binaryPrefer to self-describe
Ethnicity
Additional needs
Who holds parental responsibility?
Do they attend nursery, school or college?
Add another child
YesNo

Child four
First name
Surname
Known by
Address
Postcode
Date of birth
Gender at birth
MaleFemaleNon-binaryPrefer to self-describe
Ethnicity
Additional needs
Who holds parental responsibility?
Do they attend nursery, school or college?

Medical information
Are you registered with a doctor?
YesNo
Doctor's name
Doctor's address
Doctor's contact information
Are the children registered with a dentist?
YesNo
Dentist name
Dentist address
Dentist contact information
Do you have a health visitor?
YesNo
Health visitor's name
Health visitor's contact information

Other professionals
Are you supported by other professionals?
YesNo
Professional person 1 name
Possition

eg. Social worker
Contact information
Professional person 21 name
Possition

eg. Social worker
Contact information
Professional person 3 name
Possition

eg. Social worker
Contact information

Agencies in Blackpool are working together to meet the needs of families and provide the support that they may need at any time. We therefore need to obtain your consent to:
• Membership with the Family Hub
• Use and store your information so that we can contact you with regards to upcoming events by Family Hubs and their partners
• Record your attendance at activities by Family Hub and their partners
To discuss and signpost you to support if you feel that this is needed for you and your family.
For further details about how Blackpool Council uses your personal information please see below.
Name

First name

Last name
Date
You can withdraw consent at any time by talking to your worker or writing to the data protection officer
Privacy notice
Why do we collect your information?
The Early Help and Support Service provides and co-ordinates a range of services for children and their families designed to support them to grow, thrive and achieve This could be a group or activity in or linked to one of our Family Hubs, like a parenting course, a stay and play session or a health appointment. It could also be a family or support worker who works with families in their own home, developing an understanding of any support they need and developing a plan to make sure they get the right help. We keep your personal information because we want to know who you are. Blackpool Council want to make sure that all families are cared for and have the best outcomes. It helps us to know what help you might need. If we don’t have your personal data then you could miss out on the things that we could do for you.
What is our lawful basis?
The lawful basis for the council to collect and use your personal information is because: It is necessary for the council to perform a task in the public interest or whilst conducting its official functions, and the task or function has a clear basis in law. The relevant statute that underpins the processing is: Section 1 of The Childcare Act 2006 Children Act 2004 Section 10 Part 3 of the Children and Families Act 2014 Working Together to Safeguard Children July 2018 Chapter 1 For special category data we use the following condition for processing: (h) Health or social care We will also seek you explicit consent for additional processing activities where necessary.
What types of information do we collect?
The information we hold may include: Personal data (such as name, date of birth, address, and telephone number ethnicity, gender,). Information about your family history and your lived experience, your health, finance information, religion or who your friends are. Personal information regarding dependent children, school or nursery they attend and how often they attend, additional needs including SEND and some medical conditions. Assessment of need and agreed actions to support unmet needs Details of any risks to professionals in order to safeguard the workforce We will also collect relevant information from the agencies you consent to help with your families’ assessment and plan.
Who do we share your information with?
In some circumstances we will need to share information about you; For example: With internal Blackpool Council departments (ie. providing education, health and support services) With Lancashire County Council specifically for claim applications Early help partners who have requested this information with your consent to provide your family with support (for example education establishments, voluntary, community and faith sectors) Anonymised data will be shared with government departments - Department for Work and Pensions, Ministry of Housing, Communities and Local Government, Department for Education There are times when we have to share information about you if you are at risk from others or you are a risk to others We do not transfer your information to a third country (that is a country outside of the EEA).

Family Hub membership form

Additional information