Parent Request for EASA Involvement

This form is to be completed by parents/carers who would like support or advice from a member of the EASA team. By submitting this form you are consenting for you and your child's details to be added our database and to be contacted by EASA staff.

Please note: It may take several weeks to process your request and get back to you. In the meantime, you are welcome to come and meet members of the team at a Cuppa and Chat session. EASA is not a crisis service. 

Please complete all fields marked (*)

Parent/Carer first name *

Parent/Carer surname *

Relationship to the child

Mother

Father

Other - with parental responsibility

Please provide details

Parent/Carer email *

Child's address Line 1 (House name/number and street) *

Postcode *

Parent/Carer contact number *

Child's first name *

Child's surname *

Child's gender *

Male

Female

Not specified

Child's date of birth *

Child's autism diagnosis? *

Yes

Not yet, we are waiting for an assessment

No, we haven't requested an assessment yet

No, we do not want to seek a formal diagnosis

Please provide date received *

Child's EHCP status *

Yes

No – not applied for

No – applying for currently

No – applied for but declined

Child's age phase *

Early Years 2-5yrs old

Primary School 6-11yrs old

Secondary School 11-16yrs old

Post-16

Name of Educational Setting *

Please Select AIM North London Alan Pullinger Playgroup Alma Primary School Alpha Blocks Nursery School and Pre-Prep Angel Place Nursery Aplomb Day Nursery Ltd Arista Kids ARK John Keats Academy Armfield Playgroup Aylward Academy Bishop Stopford's C of E School Blossoming Bees Blue Planet Montessori Nursery Bowes Primary School Brettenham Primary School Bright Horizons - Bush Hill Park Bright Horizons - Enfield David Lloyds Bright Horizons - Hillyfields Bright Horizons - Palmers Green Bright Horizons - Salcombe Bright Horizons - Southgate Bright Stars Nursery - Edmonton Bright Stars Nursery - Seaton Lodge Bright Stars Nursery - Southgate Brimsdown Primary School Brown Bears Nursery Bumble Bees Montessori - Grange Park Burford Pre-School Bush Hill Park Primary School Busy Bees Day Nursery Butterflies Child & Babycare Services Ltd Capel Manor Primary School Carey Hall Pre-School Carol Jane Montessori Nursery Ltd Carterhatch Infant School Carterhatch Junior School CC's Nursery Cedar House Nursery (Hazelberry Daycare) Cedar Park Nursery Chace Community Secondary School Chase Farm Hospital Day Nursery Chase Side Primary School Chesterfield Primary School Children First Christchurch Cockfosters Pre School Churchfield Primary School Comfort Angelz Daycare Croyland Pre School Cuckoo Hall Primary Academy De Bohun Primary School Delta Primary School Dreams Nursery Durants ARP at Winchmore Secondary School Durants School Durants School Minchenden Eastfield Primary School Edmonton Baptist Church Pre-School Edmonton County School Eldon Primary School Enfield County School for Girls Enfield Grammar School Enfield Heights Academy Eversley Primary School Fatiha's Nursery Fern House School Firs Farm Primary School Fleecefield Primary School Forty Hill C of E Primary School Freezywater St Georges C of E Primary School Galliard Primary School Garfield Primary School George Spicer Primary School Gina's Montessori Nursery School Goldstar Nursery Grafton Pre-School Grange Park Prep School Grange Park Primary School Green Dragon Nursery Limited Growing Geniuses Pre-School Hadley Wood Pre-School & Playgroup Hadley Wood Primary School Happy Days Nursery Happy Woods - Enfield Happy Woods - Bell Lane Hazelbury Primary School Hazelwood Schools Head Start (Enfield) Limited Heron Hall Academy Highfield Primary School Highlands Secondary School Highlands Village Pre-School Ltd Highview Pre-School Honilands Primary School Houndsfield Primary School Inspirations Montessori Nursery Jeffrey Emmanuel Playgroup Jolly Kids Day Nursery - St Pauls Jolly Kids Pre -School - Trinity Jubilee Park Nursery Keble Prep School Keys Meadow Primary School Kids In Motion - Angel Road Community centre Kids Inc Nursery Kingfisher Hall Primary Academy Kingsmead School Latymer All Saints C of E Primary School Latymer Secondary School Laurel Park School Lavender Primary School Lea Valley Academy Leading Strings Preschool Leapfrog Nursery School - Church Hill Leapfrog Nursery School - Compton Rd Leapfrog Nursery School - Grange Park Little Learners Community Nursery - Unity Hall PC Little Learners Nurseries - Florence Hayes Little Learners Nursery - Church Street Little Learners Nursery - St Heliers Little Oaks Montessori School Little Sparkes Pre School Little Wellington's Pre-School Maple Montessori Meridian Angel Primary School Merry Days Merryhills Primary School Millbrook Preschool Limited Monkey Puzzle Moonlight Nursery New Horizons Nursery Nightingale Academy Ninos and Ninas Pre School North Start Trust Nursery On The Green Ltd Nursery on the Hill Oakthorpe Primary School Oaktree School Oasis Academy Enfield Oasis Academy Hadley One Degree Academy Orchardside School Our Lady of Lourdes Catholic Primary School Palmers Green High School Pandora Community Playgroup Park Avenue Pre-School Petite Starz Nursery EN1 Platform One Nursery Ltd Play Giggle and Grow Nursery Popcorn Nursery Prince of Wales Primary School PSD Children's Centre PSD Early Years Centre Rainbow Nursery - Firs Farm Raynham Primary School Right Start Montessori Pre-School Russet House School Salcombe Prep School Juniors Salmon's Brook School Shining Stars Cockfosters Shiny Star Palmers Green Southbury Primary School Southgate Secondary School Splash Day Nursery St Andrew's C of E Primary School (Enfield) St Andrew's Southgate Primary School (C of E) St Anne's Catholic High School for Girls St Demetrios Playgroup St Edmund's Catholic Primary School St George's Catholic Primary School St Ignatius College St James' C of E Primary School St John & St James' C of E Primary School St John's C of E Primary School St John's Nursery St John's Prep & Senior School St Mary's Catholic Primary School St Matthew's C of E Primary School St Michael at Bowes C of E Primary School St Michael's C of E Primary School St Monica's Roman Catholic Primary School St Paul's C of E Primary School St Thomas's Pre-School St. George's Pre-School St. Giles and St. John's Playgroup St. Mary Magdelene Playgroup Starks Field Primary School Stars Day Nursery Start Right Montessori Nursery School Suffolks Primary School Tara Kindergartens (Edmonton) Teensy Wonders The Hollies The Kindergarten Nursery The Latymer School The Raglan Schools Tiny Tots Pre-School Nursery Toddlers at St Barnabas Pre School Toddlers At The Bridge Toddlers Pre-School Tottenhall Infant School Tree House Friends Enfield Town Park Tree House Friends Trent Park Tree House Nursery Tree Tops Virtual School for LAC & HEART Manager Vita Et Pax Prep School Walker Primary School Waverley Pre-School Waverley School West Grove Primary School West Lea School West Lea School Haselbury Campus West Lea School Learning for Life Centre West Lea School Meridian Campus West Lea School Meridian Campus - Springfield Road Wilbury Primary School Winchmore Hill Pre-School Winchmore Secondary School Wolfson Hillel Primary School Wonderlands Preschool Woodberry Nursery Woodpecker Hall Primary Academy Worcesters Primary School Wren Academy Other

Please provide name of setting

Child's Ethnic Group

Enfield Council would like to ensure that autistic children from all the communities can access and use the provision available, your response will enable us to assess how universal the provision of the Funded Entitlement is in Enfield.

White

White-British

White-White Irish

White-White Irish Traveller

White-Gypsy Roma

White-Eastern European

White-Greek

White-Greek Cypriot

White-Turkish

White-Turkish Cypriot

White-Western European

White-Italian

White-Other

Black & Any Other

Mixed-Other

Mixed-White & African

Mixed-White & Asian

Mixed-White & Caribbean

White & Any Other

Black-Caribbean

Black-Other

Other Black African

Somali

Chinese

Asian-Bangladeshi

Asian-Indian

Asian-Other

Asian-Pakistani

Any Other Ethnic

Kurdish

I do not wish to state my child's ethnic origin

Have you contacted EASA about this child before? *

Yes

No

If yes, do you know who you spoke to?

If you are not the parent/carer listed above, please provide your name, role and contact details

How would you like to be contacted about this registration? *

Phone call

Email

Other

Please give details *

If you are new to our service please tell us how you heard about EASA