Initial Contact Registration Form

Before receiving support from Daisy Chain, it is policy and procedure around safeguarding that we must ask you to complete a registration form upon initial contact.
• The following details will be held on Daisy Chain’s database as a registration for yourself and/or your family.
• Demographic information will be anonymised when reporting statistics to funders.
• We will keep the information confidential HOWEVER if we are worried about someone’s safety then we have a duty of care to pass this on to the appropriate people.
• If you have any concerns or complaints information can be found on our website Complaints Procedure.
• For children under the age of 18, contact must be made with parents/carers to obtain consent and make them aware of our involvement.

Details of person needing support

Contact details of person needing support

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Parent details / Emergency Contact - 1

Parent details / Emergency Contact - 2

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Family composition / Significant Others

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Other professional involved in your or your family’s care

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If there is any other information that we need to know in order to support you or your family and keep you safe please let us know.