Membership form

Name *

First Name

Last Name

Partner's name

Name of your partner and/or other parent of your child/children

First Name

Last Name

Child 1 - please complete: *

First Name

Last Name

Child 1 *

Girl

Boy

Non Binary

Rather not say

Other

Child 1 - is your child on the Autism spectrum? *

Yes

No

Awaiting diagnosis

Child 2 - Please complete:

First Name

Last Name

Child 2

Girl

Boy

Non Binary

Rather not say

Other

Child 2 - is your child on the Autism spectrum?

Yes

No

Awaiting diagnosis

Child 3 - please complete:

First Name

Last Name

Child 3

Girl

Boy

Non Binary

Rather not say

Other

Child 3 - is your child on the Autism spectrum?

Yes

No

Awaiting diagnosis

Child 4 - please complete:

First Name

Last Name

Child 4

Girl

Boy

Non Binary

Rather not say

Other

Child 4 - is your child on the Autism spectrum?

Yes

No

Awaiting diagnosis

Your ethnicity *

Please tick one numbered group below, thank you:

1. Black or Black British: African

2. Black or Black British: Caribbean

3. Black or Black British: Other

4. Asian or Asian British: Indian

5. Asian or Asian British: Pakistani

6. Asian or Asian British: Chinese

7. Asian or Asian British: Turkish Cypriot

8. Asian or Asian British: Vietnamese

9. Asian or Asian British: Bangladeshi

10. Asian or Asian British: Other

11. White: British

12. White: Irish

13. White: Other

14. Other ethnicity

15. Mixed ethnicity

For your ASD child or children, please tick one or more of the following boxes:

Autism Spectrum Condition/Disorder

ADD/ADHD

Other

Type of education/work:

At mainstream school

At special school

At college

Working

Other