The MAZE SEND Programme: Booking Form
The MAZE SEND Programme is delivered in a series of videos.  

This video series will help you learn how the SEND system works and the influences and pressures on all of its parts the law and your rights.  Additionally, how to manage your emotions and understand how to master your own responses, so you can have difficult or seemingly impossible conversations, persevere until you get the outcome you want and then maintain this standard over time, through effective meetings and monitoring where to find sources of reliable information and independent support.
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Email *
Name of person completing form *
Date Form Completed *
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Parent / Carer 1 Details
Title *
Name *
Relationship to Child / Children *
Email Address *
Mobile / Telephone Number *
Post Code *
Address *
Please state any additional needs of Parent / Carer, i.e., language, physical, etc.
Name of GP Practice *
Address of GP Practice *
Post Code of GP Practice *
Parent / Carer 2 Details
Title
Clear selection
Name
Relationship to Child / Children
Clear selection
Email Address
Mobile / Telephone Number
Post Code
Address
Please state any additional needs of Parent / Carer, i.e., language, physical, etc.
Name of GP Practice
Address of GP Practice
Post Code of GP Practice
Name of person wishing to attend the Programme *
Name of Child / Young Person (1) *
Gender *
Date of Birth *
MM
/
DD
/
YYYY
Child's School *
Is your child or young person's additional need diagnosed? *
What level of SEND support is your child currently receiving? *
Name of Child / Young Person (2)
Gender
Clear selection
Date of Birth
MM
/
DD
/
YYYY
Child's School *
Is your child or young person's additional need diagnosed?
Clear selection
What level of SEND support is your child currently receiving?
Clear selection
Name of Child / Young Person (3)
Gender
Clear selection
Date of Birth
MM
/
DD
/
YYYY
Child's School
Is your child or young person's additional need diagnosed?
Clear selection
What level of SEND support is your child currently receiving?
Clear selection
What are your reasons for signing up for this course? *
What area of SEND would be most useful for you to understand? *
What are the specific needs of your child that are the most challenging for you?
 *
What other difficulties are you experiencing as a result of your child’s needs?
 *
Did you have a positive referral experience into The MAZE Group?
 *
Required
Please rate the following statements
You were able to access the right support for your child or young person at the right time.
 *
Your child or young person's needs are understood by the professionals that support them.
 *
You feel informed by the professionals involved in your child or young person's care.
 *
You feel listened to by the professionals involved in your child or young person's care and education.
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You found it easy to access support.
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Please score the following questions
How confident do you feel managing conversations about your child's provision? *
Not at all confident
Very confident
How confident do you feel about your knowledge and awareness of SEND provision? *
Not at all confident
Very confident
What topics related to SEND support would you like to learn more about? *
How would you rate the SEND provision for your child? *
Poor
Excellent
What do you hope to get out of this course? *
Who referred you into this service? *
Name of Referrer (if not self-referral)
Organisation of Referrer (if not self-referral)
Referrer's Email Address (if not self-referral)
Referrer's Mobile / Telephone Number (if not self-referral)
Any other agencies involved?  (e.g., Social Care, EWMHS, Family Solutions, etc.)
Any Additional Information
Terms & Conditions
1. Accessing our Services
Applications to access The MAZE SEND Programme are through referrals and are considered on completion of a booking form.  
The MAZE Group will make contact to acknowledge the booking form within 7 days and where applicable arrange for payment of the Programme.
Once payment has been received, The MAZE Group will provide login details to access the videos.
Videos are set with a 6-month expiry date and are non-downloadable.  
Sharing of these videos is not prohibited.
Under the terms of our funding, we must obtain certain information; this includes your child or young person's gender, date of birth, current school setting, details of your GP surgery and where you currently are on the Neurodevelopmental Pathway.  If this information is not provided then unfortunately we are not able to offer you access to the Programme.

2. Fees
All parents/carers whose GPs are located in North-East Essex are able to access the Programme at no cost due to funding from North-East Essex’s Clinical Commissioning Group.  For those outside of North-East Essex there is a nominal fee of £25.  

3. Completion of the Programme
On completion of the Programme, The MAZE Group would be grateful for an evaluation form to be completed.  Under the terms of our funding, we are required to obtain feedback from attendees of our Programme.  

Please tick this box to confirm that you have read and understood The MAZE Group CiC's Terms & Conditions *
Required
MAZE Monthly Newsletter - on receipt of your referral form we will automatically register you to receive our monthly newsletter.  This is to enable you to receive updates, events and resources.  Please tick the relevant box below to give or refuse consent.
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Privacy Policy
The MAZE Group CiC takes data protection and confidentiality very seriously, and complies with the Data Protection Act 1998.  They are committed to ensuring that all personal data is stored securely, and will not be passed on to third parties unless instructed to do so.  Please refer to our Privacy Policy on the website for full details on the data we collect, store and process: https://www.themazegroup.co.uk/wp-content/uploads/2019/09/MAZE-Privacy-Notice.pdf
Please tick this box to confirm that you have read and understood how The MAZE Group CiC collects, stores and processes your personal data. You can withdraw your consent at any time by emailing amanda.towns@themazegroup.co.uk.  Please note that withdrawing consent may result in your place being withdrawn on the Programme. *
Required
A copy of your responses will be emailed to the address you provided.
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