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Are You a Young Person or Parent/Carer?
First Name *
Last Name*
Your Date of Birth
Your Postcode*
Email
Phone Number*
Do you have Sight Loss Registration (CVI)
What is the level of sight loss?
What is the sight loss diagnosis (if known) ?
What was the date of diagnosis (if known) ?
Which service are you mainly interested in?*
Which other services would you be interested in?
Do you have any additional needs: (e.g. learning, medical, mobility, dietary etc)?
Do you require any support to access RSBC activities (e.g. sighted guiding)?
How did you hear about RSBC? (social media, google search, friend/family, professional, website, other)
First Name*
Last Name *
Phone Number
Your Postcode *
Does your child have Sight Loss Registration (CVI)
Which service are you mainly interested in? *
Do you or your child have any additional needs: (e.g. learning, medical, mobility, dietary etc)?
Do you or your child require any support to access RSBC activities (e.g. sighted guiding) ?
"If you are a professional working with a family and making a referral to RSBC’s support and services, please share your details here:"
Your Name
Your Organisation and Role
Your Contact Details (email &/or phone no.)
By submitting this form, you give your consent to share this information with RSBC. Your details (and those of the person you are referring) will be stored confidentially by RSBC on a secure database in accordance with the General Data Protection Requirements (GDPR) and will be used to provide you with service information and ongoing support. Information would only be shared without your permission if you or a family member appears to be at risk of harm. You can opt out of these data agreements at any time by contacting connections@rsbc.org.uk or calling 020 3198 0225.