Parent and carer panel – registration of interestParent panel sign up formWe are recruiting people to join our Advisory Panel of parents and carers who can help shape our services, policies and strategy, and share their experiences of being a parent or carer in the UK. Find out more details about what is involved.HiddenName*Name* First Last Email*Please leave an email address so that we can reply to you. Enter Email Confirm Email Phone numberHow many children under the age of 18 do you have?* 0 1 2 3 4 or more HiddenDo you have caring responsibilities for someone else (not as a job)?*Please choose –NoYes – I look after a child with a disabilityYes – I look after an adult with a disabilityYes – I look afer a child and an adult, both with disabilitiesYes – I care for another adultYes – I care for a child who is under 18Prefer not to sayAre you are carer for someone (not as your paid job)?*This isn’t the same as being a parent, although you may be a carer for you child if they have additional needs. E.g. you might care for an elderly relative or a disabled child or adult)Please choose –NoYes – I look after a child with a disabilityYes – I look after an adult with a disabilityYes – I look afer a child and an adult, both with disabilitiesYes – I care for another adultPrefer not to sayDo you live with a disability and/or long term health condition?*This might include a physical, sensory, or cognitive disability, or moderate to severe mental health condition Yes No Prefer not to say Please could you tell us what type of disability and/or long term health condition/s you have?* Mental Health Physical Cognitive Sensory Other Prefer not to say We will be in communication via email and will host group discussions online for those who would like and are able to join. You are welcome to change your communication preferences at any time. Do you have any communication difficulties due to a disability?* Yes No Prefer not to say Are there any adjustments we could make to make group sessions or individual communications more accessible for you?*Please let us know how we can help.Are you happy and able to use video-conferencing technology (such as MS Teams or Zoom) to speak with us and other panel members?* Yes Yes, but I may need some help No – I do not have a device that allows me to use video-conferencing No – I have a device but I am not happy to video-conference What times are you generally available?This will be to help us organise a future information event, which will be no more than 1 hour long.Please tick all that apply.Monday Morning Afternoon After 6pm Tuesday Morning Afternoon After 6pm Wednesday Morning Afternoon After 6pm Thursday Morning Afternoon After 6pm Friday Morning Afternoon After 6pm Saturday Morning Afternoon After 6pm Sunday Morning Afternoon After 6pm Why would you like to be part of the parent panel?Please enter any information about why you would like to take part, and any other information that might be useful.Help us by filling in this monitoring form (optional)We would like to check that we reach a broad range of people from across the UK with differing financial and personal circumstances. This monitoring information will be completely anonymised and used for internal monitoring purposes only.How did you find out about the parent panel?Please select –via an emailvia social mediaWorking Families websiteword of mouthotherWhat best describes your employment status?Please choose –EmployeeSelf-employedWorker (e.g. agency worker or zero hours contract worker)Not employedI don't know my employment statusMix of the abovePrefer not to sayWhere are you based?Please select –EnglandScotlandWalesNorthern IrelandIf you are based in England, can you tell us where you are contacting us from?Please select –North (East and West)Yorkshire and HumbershireMidlands (West and East)AngliaSouth (West and East)LondonNot sure/Prefer not to sayWhat is your gender?Please select –Female/WomanMale/ManNon-binaryTransgenderOtherPrefer not to sayAre you a single parent/carer?Please select –YesNoPrefer not to sayDo you receive Tax Credits, Universal Credit or any other low-income benefit? Yes No Not sure Please estimate your pre-tax household incomeThis information allows us to better understand our service users and fund our work providing free legal guidance. £0 – £19,999 £20,000 – £29,999 £30,000 – £39,999 £40,000 – £49,999 £50,000 – £59,999 £60,000 – £69,999 £70,000 – £79,999 £80,000 – £89,999 £90,000 – £99,999 £100,000 or over HiddenIs your annual household income below £35,000? (Gross income, before tax)Please choose –YesNoPrefer not to sayHiddenIf you are in a couple: Is your annual household income below £41,000? (Gross income, before tax)Please choose –YesNoPrefer not to sayHow would you describe your ethnic origin or ethnicity?Please select –White UK/IrishWhite – otherAsian/Asian BritishBlack/African/Caribbean/Black BritishMixed ethnic originOtherPrefer not to sayEthnic originplease specifyHiddenAddressplease don’t fill this outPrivacyWe won’t share your details with anyone outside the Working Families’ team (except for our volunteers, and in some cases, auditors – who are also bound by confidentiality) without your permission. We do store your contact details on our internal database in accordance with GDPR for monitoring, funding and training purposes. By contacting us, you agree to us processing your information in this way.Read our privacy policy.Do you consent to your data being used in accordance with our privacy policy?* Yes No Unfortunately we cannot get in touch with you without your consent. If you would like us to contact you, please tick the consent box above.NameThis field is for validation purposes and should be left unchanged.Δ
