Consent Form for EYSAT Area SENCo Involvement

The Early Years Support & Assessment Team (EYSAT) has been asked by the setting/school your child attends to become involved to help with the planning of support for certain concerns and needs.  We therefore want to be sure that you understand who we are, what we do, and that your consent is freely given. 

The school or setting will have talked to you about EYSAT.  EYSAT is part of Solihull Metropolitan Borough Council’s SEND 0-25 Service. We are qualified Specialist Teachers and Specialist Inclusion Support Practitioners (ISP’s).  Our main aim is to provide support, advice, training and Information to school nurseries and PVI settings for children with Special Educational Needs and Disabilities (SEND) to help make sure that all children are fully included within the setting.  We help support families, schools and other settings to identifying solutions alongside other professionals (including health) who may also be involved. Our work may involve consultation meetings, training, assessments, observations and planning interventions.  

We will always share the outcomes of our involvement with you, your family and your child.  

As part of our work we keep electronic records, which are held securely and confidentially.   These records contain personal information, such as name, and date of birth, plus the details of our work with the child/young person. Since we work alongside other professionals who may also be involved, we would want and may also exchange information with these other practitioners. Please note that any, personal data collected will be stored and managed in line with Solihull Borough Council’s  commitment to the General Data Protection Regulations. Please visit Privacy Statement.

If you are happy for us to work with your child, please complete and sign section 2 of this form. The school/setting will give you a copy of the form and send the original to us.

1. Child/Young Person’s Details  setting to complete	
Name (please print)	DOB 

Setting/School
	
Home Address 

	Post Code	

2.	Parents’ / Carers’ Details
To be completed by the person/people with parental responsibility for the child/young person

•	I give consent for an EYSAT professional to become involved. I understand this may involve consultation with staff in the educational setting and other professionals who are involved. There may also be observation and assessment of my child. 
•	I give consent for the exchange of information with other services including health agencies who are involved.  
•	I understand an electronic file will be opened for my child and that information will be stored securely.
•	I can discuss the purpose and continuation of consent at any time with the EYSAT professional. 
	
Name 

	Relationship to Child 

Signature 
	Phone contact 
	
Name 	Relationship to Child 

Signature 
	Phone Contact 
	
Home address if different from the child – please specify which parent or carer 

Additional Comments regarding consent and sharing information – When our involvement begins we will secure other important information you want to share.

	

3.	School / Setting Staff Details
	
Name 

Designation 

	Date	
The role and purpose of EYSAT involvement has been discussed with the parent/carer - please circle 
	
YES	
NO	
Signature
	Phone and email contact information

	
The information on this form will be recorded on a database along with any details relevant to subsequent EYSAT involvement. These records will be held and used in accordance with the Data Protection Act 2018 and the General Data Protection Regulation 2018.  We are compliant with Solihull Metropolitan Borough Council’s Privacy Notice www.solihull.gov.uk. This information is being collected for the purpose of determining the educational needs of the named child or young person. It may also be shared with other professionals actively involved with the names child or young person, to inform their work. The information collected may also be used for the wider purpose of providing anonymous statistical data used to assist with monitoring provision and/or determining areas of need in order to target future resources. 

If the request is agreed the duration for which consent is given will be shared with the setting, parents/carers and young person.  A consent form cannot be accepted and the information will not be held by the EYSAT  if it is more than 2 months after it was signed and/or if there was no prior agreement with the allocated EYSAT Practitioner.

Office Use Only - Request for EYSAT involvement 

Received   ______________Date.                    Agreed    Yes/NO please circle