Skip to main content
Hartlepool Now
{{ show_overlay ? 'Close' : 'Menu' }}
Create account
Forgotten your password
Log in
Organisations
Childcare
Information & Advice
Events
SEND Local Offer
Warm Hubs
News
Search
Try finding what you are looking for by using key words
Search
Create account
Forgotten your password
Log in
Email Hartlepool Now
Hartlepool Children’s Disability Register Application Form
Child's First Name
*
Child's Surname
*
Date of birth
Clear date input
Open calendar
Gender
Male
Female
Name of nursery, school or college
Child's home address and postcode
Mobile telephone number
Email address
*
Name of the person filling in this form
Relationship to the child
Are you happy to receive information on events and services relating to short break activities?
Yes
No
Would you like a max discount card?
Yes
No
How would you like to receive further information?
Email
Post
Communications
Does this child use
BSL
Makaton
PECS
Alternative/personalised form of communication
Does this child require
A Signer
An Interpreter
Child's first language
Educational Needs
Does this young person have an Education, Health and Care plan?
Yes
No
Disability Details
Please tick the areas your child has difficulty in
Physical disabilities
Complex health needs
Learning disabilities
Autism Spectrum Condition
Speech/language difficulties
Visual impairment
Hearing impairment
Behavioural/Emotional Difficulties
Social communication difficulties
Other
If other, please state
Diagnosis
If the child does not have a diagnosis, please describe how their disability affects them
All information is sent directly to the Adult Social Care team at Hartlepool Council and will be treated in strictest confidence.
Send Application