Request for involvement of the EnhancedMainstreamSchool (EMS)

for Communication and Interaction

Informed Parental Consent

Date:

Dear (Parent’s name)

Re: (pupil’s name and date of birth

We have contacted the Teacher-in-Charge of Kirkbymoorside EMS for Communication & Interaction to discuss ………. and his/her progress within school. We would like Kirkbymoorside EMS to become more involved in supporting us. The Teacher-in-Charge may direct other staff from the EMS to work closely with school staff and other professionals or with … … …. as part of a group or individually.

I would be grateful if you would give your written permission for specialist staff from Kirkbymoorside EMS to take on this work by signing the consent form below and returning the whole of this letter to school. A member of the specialist staff from Kirkbymoorside EMS may contact you directly, but I assure you that we will keep you informed of the progress your child is making.

If you wish to discuss the matter further before signing below, please do not hesitate to contact me on telephone no.

If you would like to find out more about the EMS please see for more information or look at the website for Kirkbymoorside Primary School.

Yours sincerely,

Special Educational Needs Co-ordinator (SENCo)/Inclusion Manager

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I agree to the involvement of the Enhanced Mainstream School for Communication & Interaction and understand that this may involve specialist staff working directly with my child.

If we agree together that it is in the best interests of my child, I understand that some information (for example a report) about my child may be shared with other professionals who are already involved with my child. This will be done in line with NYCC Children & Young People’s Service Information Sharing Protocols (for reference, I will ask to see a copy or this can be found at - This will only be information that is relevant and necessary, with the people who need the information and when there is a specific need for the information to be shared at that time.

You will seek further consent from me if you want another service, not already involved, to see or work with my child.

I understand that both paper and electronic records may be kept by Children & Young People’s Service as a result of this involvement and that these records will be kept securely by NYCC and destroyed safely, according to the County Council's Document Retention and Deletion Schedule.

Under the Data Protection Act 1998, I have the right to request a copy of the information the County Council holds about me/my child. For more information I can contact the Data Management Office at or Data Management Officer, Internal Audit Service, County Hall, Northallerton, North Yorkshire, DL7 8AL

Please sign below if you have parental responsibility for the pupil named above

Signed: …………………………………………………Date: … … … … … … … … … … … …

Please print your name and relationship to the child…… … … … … … … … … … … … … …

Address: ………………………………………………… Telephone: ………………………..

SEND Support and Outreach EMS Sept 2012