Please enable JavaScript in your browser to complete this form.Name *Postcode *Date of birth *Have you taken a parent education course or received relationship support in the last 12 months? *Please selectYesNoHow many children do you have in the following age groups? 0 – 6: 7 – 11: 11 – 18: What is your current parenting status or relationship to the child? *Two-parent family living togetherParent living apart from co-parentStep parentFoster parentGrandparentRelative/Family friendNon-resident ParentEducator/advocateOtherIf other, please describe. What is your ethnic group? *Please selectAfricanCaribbeanBlack/ African/Caribbean/Black BritishBangladeshiIndianPakistaniAsian/Asian BritishAsian/WhiteBlack African/WhiteBlack Caribbean/WhiteMixed/Multi ethnic groupsChineseArabWhite (UK)White (other)IrishGypsy/IrishTravellerOtherIf other, please describe. What is your first language? EnglishSpanishFrenchGermanChineseJapaneseRussianItalianPortugueseArabicKoreanHindiTurkishDutchSwedishNorwegianDanishFinnishGreekCzechHungarianThaiVietnameseIndonesianHebrewSwahiliBengaliMalayFilipinoUkrainianRomanianBulgarianSlovakCroatianSerbianLithuanianLatvianEstonianCatalanBasqueIcelandicWelshIrishScottish GaelicMalteseAlbanianBosnianSlovenianGeorgianArmenianKazakhUzbekPersianTamilTeluguMarathiPunjabiMalayalamBurmeseKhmerSinhaleseLaoMongolianTibetanPashtoFarsiSomaliHausaAmharicYorubaIgboZuluXhosaSesothoTwiAkanOtherBy this we mean the first language you learnt, or the language that you grew up speaking.If other, please describe.How do you personally define your gender *Please selectManWomanTrans manTrans womanNon binaryOtherPrefer not to sayDon't knowPlease tell us in your own words below if none of the categories above are right for you.If other, please describe. Is your gender identity the same as the one assigned to you at birth? *Please selectYesNoDon't knowPrefer not to sayWhich of the following best describes your sexual orientation? *HeterosexualLesbianGayBisexualOtherFaith / Religion / Belief *Please selectNo religionChristianBuddhistHinduJewishSikhMuslimOtherIf other, please describe. What is your household income level (per year) *Under £5000£5000 - £10,000£10,000 - £20,000£20,000 - £45,000Over £45,000Don't knowPrefer not to saySchooling completed *Primary schoolSecondary school (aged 16)Secondary school (aged 18)Undergraduate or postgraduate degreePlease select the highest level that you completedDo you have any special educational needs/disability?Special education needsDisability needsNone of the abovePrefer not to sayIf you would like, please specify Do any of your children have any special educational needs/disability? Special education needsDisability needsNone of the abovePrefer not to sayIf you would like, please specify Why are you taking this course? *To become a better parentHaving problems with childrenTo improve communication with my co-parentTo avoid court proceedingsOtherIf other, please describe.How did you hear about the course?Flyers/AnnouncementsFriend/relativeInternet searchSocial MediaNewspaper/NewsletterSelf-ReferralReferralOtherClick all that apply If other, please describe.Through what referral agency did you hear about this course?Social worker or Early Help workerCommunity groupsLegal Cafcass or solicitorParenting and Support NetworksSchool ReferralOtherName of referral agencyPhoneSubmit
