Please select which area your child with SEND attends education or is registered with a GP*

Please tell us the main reason you are contacting Amaze*

If you only want to discuss the Brighton & Hove Compass card or Carers’ Card it will be quickest if you complete the form found on our Compass contact page here, or email us at compass@amazesussex.org.uk. Do you still want to continue?

Tell us a bit more about why you are getting in touch.*

Tell us about any conditions or diagnoses of your child or young person.  If you are seeking advice from SENDIASS or around benefits this will help us to respond to you faster.*

Please confirm that you are happy for Amaze to store the information you provide in this form about yourself.  For further information, please see our Privacy Policy.*

Your first name*

Your last name*

Your email address*

Your mobile number

Your landline number

First line of your address*

Second line of your address

Town/City*

Postcode*

What is your gender?*

If other, please tell us your gender

Is this the same gender you were assigned at birth?

Where did you hear about us? 

Have you already recently told us this information (ethnicity, disabilities etc.)?*

Your age range (please ignore the lower age ranges, these come directly off our system)*

What is your ethnicity?*

If other, please tell us your ethnicity

How would you describe your sexual orientation?*

If other, please tell us your sexual orientation

Your religion or belief*

Is spoken English your main language at home?

If no, what is your main language at home

How has your mental health been impacted by your caring role?

How has your physical health been impacted by your caring role?

Do you consider yourself to have a disability, long term health condition or are neurodivergent?*

Do you consider yourself to be disabled as set out in the Equality Act 2010?*

Physical impairment

Sensory impairment

Autism

Attention Deficit Hyperactivity Disorder (ADHD)

Mental health condition

Learning disability

Dyslexia

Any other condition or disability

Long term health condition

Do you receive Personal Independence Payment (PIP) for yourself?

What is your relationship to the child or young person?*

Do you have parental responsibility for this child or young person?*

Please confirm that if your child is under 16 years you are happy for Amaze to process the information you provide or if they are over 16 years they have consented for you to share this information.  For further information, please see our Privacy Policy.*

Child or young person’s first name*

Child or young person’s last name*

Child or young person's date of birth*

Their gender identity*

If gender is not listed, please describe

What was their sex assigned at birth?*

What is their ethnicity?*

If ethnicity is not listed, please describe

Would you like to receive the Amaze termly e-newsletter about SEND issues and news?  If so, please select the area.*

Would you like to receive emails from us about SEND issues we think you might be interested in?  This could be based on the information you have provided to us about you or your child*

Would you like to receive emails from us about fundraising or fundraising events with Amaze?

Would you like to answer 13 questions about your caring role?*

Thinking about who cares for you child in your household, which statement best describes you?*

On average, how long do you spend each week looking after or helping your child(ren) (additional to ‘normal parenting’ role) as a result of their special educational needs or disabilities?*

When did you last get at least 24 hours+ break from your caring role?*

Do you usually get a good night’s sleep?*

Are you a single-parent family/household?*

Do you ever reduce the size of your meals or skip meals for the family because there isn’t enough money for food?*

Have you been offered a Carers’ Assessment (where someone asks about your needs as a carer) in the past 12 months?*

Do you have a Carers' Card?*

Thinking about how much social contact you have with people you like, which of the following best describes your social situation?*

Do you do paid work?*

How has your ability to work (gain paid employment) been affected by your caring role?*

Are you in receipt of Universal Credit or ESA/Tax Credits (working or child)?*

Does your household rely solely on benefits?*