Please enable JavaScript in your browser to complete this form.Name of parent/carer that will be present at every session *FirstLastSecond parent/carer name (if applicable)FirstLastChild's name *FirstLastAny other children in the family? If so, please provide names and ages.Child's date of birthEmail address *Phone number (if you would like to be contacted via WhatsApp)Address *Nursery/preschool/school attending (if any) The following questions form the registration survey.I understandPlease see our Safeguarding Policy linked in our Resources section above. Please confirm that you have read and agree to abide by our Safeguarding Policy when undergoing PACT intervention. *I agreeI do not agreeI understand that if I am not able to attend a session, I will give Amanda Haydock 24 hours' (or more) notice, or I will need to pay for the session. *I understandI do not understandI understand that I need to pay for the month's sessions in advance, at the rate agreed with Amanda Haydock. *I understandI do not understandI agree that Amanda Haydock, for Spectrum Connection CIC (registered with ICO), can store any videos I send as part of the support provided, in an encrypted file, in accordance with GDPR, for the duration of the support. *I agreeI do not agreeDo you have any questions about the support you are about to undertake?Submit