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Emotion Coaching Referral
Data protection agreement
In this form we ask for some personal information, including contact details in order to fulfil your request to participate in Happier Families.
Any processing will be performed in line with the Data Protection Act 1998.
Our registration number with the Information Commissioner’s Office is ZA361968. Please read the privacy notice below to ensure you understand how we process personal data.
Link to privacy notice -
https://docs.google.com/document/d/1BIj0Io22DdO9MM8dqVTmvc6Mm4F3PVmlBQo-LomPj4g/edit?usp=sharing
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Full Name of Parent
*
Your answer
Name of child/children (including surname )
*
Your answer
Age of Child/Children
*
Your answer
Contact Telephone number
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Your answer
Contact Email
*
Your answer
Address
*
Your answer
Reason for making referral
*
Your answer
Preferred program delivery
*
Face to Face
Virtual
How did you hear about Emotion Coaching? (If from a school please state which one)
*
Your answer
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