Haggeye Jnrs Registration Form
Section 1
Name of child:
Address:
Post code:
Home telephone number:
Mobile telephone number:
Email:
Date of Birth:
Age:
Gender:
What is your child’s eye condition?
Are they registered Blind or Partially Sighted:
What is your preferred reading medium?
(Please state 1st choice with a 1, 2nd choice with a 2 etc.)
Standard Print. This will be font size 14.
Large Print. State your preferred font size here:
Word documents on CD
Audio: please state which type of audio:
Braille
Child is read to
Section 2
Name of Parent/Guardian:
Relationship to child:
Address:
Post code:
Home telephone number:
Mobile telephone number:
Email:
What is your preferred reading medium?
(please state 1st choice with a 1, 2nd choice with a 2 etc.)
Standard Print. This will be font size 14.
Large Print. State your preferred font size here:
Word documents on CD
Audio: please state which type of audio:
Braille
Section 3
Please let us know any medical and/or dietary information and other support requirements your child may have:
Allergies (incl. symptoms and treatment):
Dietary requirements:
Any other requirements:
Does your child have any accessibility or other requirements you feel it would be helpful for us to know about so that we can support you to participate in Haggeye Jnr activities?
Please add any comments or information that you feel we should know about or that you want to tell us:
What size of t-shirt would you like for your child? (Please indicate)
Small (child)
Medium (child)
Large (child)
X-small (adult)
Other (please specify)
How would you describe your child’s ethnicity:
(Please choose one from the list below)
White
Scottish
English
Welsh
Northern Irish
British
Irish
Gypsy/Traveler
Polish
Other White Ethnic Group, please specify:
Asian, Asian Scottish or Asian British
Pakistani, Pakistani Scottish, Pakistani British
Indian, Indian Scottish, Indian British
Bangladeshi, Bangladeshi Scottish, Bangladeshi British
Chinese, Chinese Scottish, Chinese British
Other, please specify:
African, Caribbean or Black
African, African Scottish, African British
Caribbean, Caribbean Scottish, Caribbean British
Black, black Scottish, Black British
Other Ethnic Group
Mixed or Multiple Ethnic Group; please specify:
Arab
Other, please specify:
Declaration
I (parent/guardian) agree to joining Haggeye Jnrs.
I have given details on the 'Registration Form' of all medical conditions of my child/ward.
I have notified you of all allergies and the symptoms and treatment associated with them on the 'Registration Form'.
Signature of parent/guardian:
Print name:
Date Consent Form signed:
Request to be Added to the Database
Fair Processing Notice
In order to provide you with the best and most efficient service, RNIB needs to use some personal information about you, so that we can deliver services to you.
We do not trade or share customer data outside RNIB unless required by a legal duty. If we need to refer you to another organisation, as part of the service you are receiving from us, we will confirm with you each time that you are happy for us to release your information.
The RNIB Group Data Protection Policy is available on request.
Please indicate that you have read the above and either;
Consent or Do Not Consent(delete/circle as appropriate)
To being added to the database.
Mailing List
Your consent to being added to the Mailing List when you return this form will be automatic.
Signature Parent / Guardian (if child/children under 18):
Date:
Please complete and return the registration form to Haggeye Jnr, RNIB Scotland, 12-14 Hillside Crescent, Edinburgh EH7 5EA
Tel: 0131 652 3140
Email: