Parental Consent Form Name of child: Date of birth: __.

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Presentation transcript:

Parental Consent Form Name of child:____________________________________________________ Date of birth: ______________________________________________________ School: ____________________________________________________________ We request your permission to refer your child to Westminster Outreach Autism Advisory Service and to be observed by an Autism Advisory Teacher. Please sign below to give your consent Name of parent(s)/carer(s)___________________________________________ _____________________________________________________________________ Date:________________________________________________________________ Please tick both boxes below if you give permission I/we agree to our child being photographed/filmed to show their progress (to be viewed only by the school and outreach team) I/we agree to film/photograph of our child being used for training purposes (To be viewed by other professionals and parent groups) Please email us if you have any queries: training@qe2cp.westminster.sch.uk Westminster Special School Outreach Service Queen Elizabeth 11 Jubilee School, Kennet Road, London, W9 3LG Tel:07538639449, Fax: 020 7641 5823