Join the RPCAG

Please complete the following details and click on “Apply”. We will add your email address to our mailing list and be in touch as soon as we can.

If you prefer you can download the application form, fill it in off line and email it to us. The form can be downloaded by clicking on the following link

Application Form

Title:

First Name:

Last Name:

Address:

Postcode:

Email:

Home phone:

Work phone:

Mobile phone:

Age group:

How did you hear about us?:

Child details
First name:
Last name:
Date of birth:	Day: Month: Year:
Additional needs of your child:
Ethnic background of your child with additional needs if different from your own: Please specify:

Siblings
First name:
Last name:
Date of birth:	Day: Month: Year:
Additional needs of your child:

RPCAG monitors all our users to help us promote equality of access. Please select the appropriate choice to indicate your ethnic background.:

Please specify:

As part of the Government’s Aiming High for Disabled Children the Parents of the Borough of Richmond upon Thames have set up the Richmond Parents Carers Action Group.
The group’s aim is to develop parent participation with local authority, PCT, Social Services and Education. We are supported by Contact a Family and Me Too and Co.
In order to be effective we need as many parents of children with additional needs as possible to join us; the more participants we can get on board, the more influence we will have on policies and issues affecting our children within the borough!
Please could you let us know of any issues that are affecting you and you child at the moment that we may be able to help you with…

Are you be happy for us to contact you by email?:

By which method would you prefer us to contact you?:

Would you be happy for photographs of you and your children to be used in publicity material?:

Yes No

Tick this box to show you agree to your details being held on our database under the terms of the Data Protection Act 1984:

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