Apply for the group

Apply to join the group

If you're thinking about applying for a group, you may want to download our welcome information before you complete the form below. Please also read our PRIVACY POLICY before applying.

Application form

Name of child:*
Date of birth:
Name of parent or carer:*
Do you have parental responsibility for the child? If not, what is your relationship to the child?:*
Address:*
Telephone Number (mobile preferred):*
Email:*
Emergency contact details (in case of emergency at group):*
Please tell us a little about how your child communicates (E.g. How do you know if he or she wants something, or wants you to do something?) :*
Any particular interests/things he or she especially likes… :
Any fears/things he or she dislikes… :
What other agencies are involved with your child? e.g. nursery, speech & language therapy, social service, pre-school support etc:*
Please tell us why you would like a place, and anything else you’d like us to know:
How did you hear about Speech, Sign and Song?:
Are you applying for the weekly pre-school group or the monthly school-age group?:
- Weekly
- Monthly

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A note about siblings: we encourage you to find care for other children during the group if possible, so that you can give your full attention to the child who has a communication difficulty. However we don't want this to prevent you from being able to attend. Please contact us to discuss including another child if necessary.

Please note: if you book a place you will need to be available on Wednesday mornings in term time in order to attend the group in Beeston,