Application to join Special Kids in the UK

Please complete all areas of the form where applicable. You must be 18 years of age or older to register.

Your Full Name * required
Address 1 * required
Address 2 * required
Address 3
County * required
Postcode * required
Your email address * required
Retype email address to confirm * required
User name (please specify the user name you would like to use to sign into the website members area and forum) * required
Password * required
Special Needs Child 1
Name * required
Date of Birth * required
What are your child's special needs (and condition name if known) * required
Your relationship to the child * required	Parent Carer Foster parent Other parent/carer (please specify)
Special Needs Child 2 (leave blank if not applicable)
Name
Date of Birth
What are your child's special needs (and condition name if known)
Your relationship to the child	Parent Carer Foster parent Otherparent/carer (please specify)
If you have more than 2 children with Special Needs, please add their details here:
Any other information you would like to share that you feel is relevant
How did you hear about Special Kids in the UK?	Search Engine Word of Mouth Local publicity Other (please specify)
Why do you want to join Special Kids in the UK? * required

Data protection: In addition to sending you our quarterly newsletter, we would like to contact you occasionally with information about Special Kids in the UK and other ways you may be able to support our work. Please tick here if you do NOT wish to be contacted by email: or post:

Thank you for providing the above information. Special Kids in the UK will never disclose or pass your details onto any third party organisation without prior approval by yourself.