Lighthouse (*)
Beaconsfield
Cressex
Haddenham
Hazlemere
High Wycombe
Loudwater
Mansfield
Marlow
Princes Risborough
Safe Harbour
Shelswell
Water Eaton
Lighthouse Beaconsfield is held at The Beaconsfield School, Wattleton Rd, Beaconsfield HP9 1SJ. From Monday 24th July 2023 to Friday 28th July 2023.
Lighthouse Cressex is held at Cressex Community School, Holmers Lane, High Wycombe, HP12 4QA. . From Monday 24th July 2023 to Friday 28th July 2023.
Lighthouse Haddenham is held at Haddenham. From Monday 21st August 2023 to Friday 25th August 2023.
Lighthouse Hazlemere is held at Hazlemere CofE Combined School, 262 Amersham Rd, Hazlemere, High Wycombe HP15 7PZ. From Monday 24th July 2023 to Friday 28th July 2023.
Lighthouse High Wycombe is held at The Highcrest Academy, Hatter's Ln, High Wycombe HP13 7NQ. From Monday 24th July 2023 to Friday 28th July 2023.
Lighthouse Loudwater is held at Carrington Junior School, 4 Chapel Road, Flackwell Heath, High Wycombe, Buckinghamshire, HP10 9AA. From Monday 21st August 2023 to Friday 25th August 2023.
Lighthouse Mansfield is held at Queen Elizabeth’s Academy 150 Chesterfield Road South Mansfield Nottinghamshire NG19 7AP. From Monday 31st July 2023 to Friday 4th August 2023.
Lighthouse Marlow is held at Holy Trinity CE School Wethered Road, Marlow, Buckinghamshire, SL7 3AG. From Monday 31st July 2023 to Friday 4th August 2023.
Lighthouse Princes Risborough is held at Princes Risborough School, Merton Rd, Princes Risborough HP27 0DR. From Monday 31st July 2023 to Friday 4th August 2023.
Lighthouse Shelswell is held at Finmere School, Mere Road, Buckingham, Buckinghamshire MK18 4AR. From Monday 24th July 2023 to Friday 28th July 2023.
Lighthouse Water Eaton is held at Water Eaton Church Centre, Drayton Road, Bletchley, MK2 3RR. From Monday 31st July 2023 to Friday 4th August 2023.
First Child
Forename (*)
Surname (*)
Gender (*)
Date of birth (*)
School attended (*)
Church attended (if any)
You can list two children, in the same age group as your child, that you would like your child to be with at Lighthouse. We will do our best to put them in the same Lighthouse group.
Days attending. We would suggest that your child attends all week as we have found that children become upset when they leave early but their friends do not.
Does this child need care during the morning helpers briefing? (*)
Does this child need to be in creche? Only volunteers' children and grandchildren are guaranteed places whilst the volunteer is on site. (*)
Please indicate whether your child is likely to need to use an inhaler or epipen during Lighthouse week.
Is your child taking any medication regularly? (*)
Has your child been immunized against tetanus within the last five years? (*)
Does your child have any other medical conditions we need to be aware of, including allergies? (*)
As part of the Lighthouse programme, we may want to treat your child to a sweet, biscuit or similar, is this acceptable? (*)
Does your child have any special or additional needs? (*)
Lighthouse Additional Needs Questionnaire
Please complete this form if there are any additional needs or circumstances that may impact your child's time at Lighthouse. For example, special educational needs, if they have an EHCP, if they are a looked after child, or anything else you would like us to be aware of. We want to make sure your child has the best experience of Lighthouse so need to ensure we can care for them safely and sensitively.
We will do all we can to accommodate special and additional needs applications but in order to ensure the appropriate support can be available at the Lighthouse you are applying for it is essential that you provide as much information as possible in order to help us best assess whether we can meet the needs of your child.
Lighthouse Safe Harbour (previously Bourne End) is a specialist LH and if you wish to apply for a place for your child please read the attached document first. Lighthouse Safe Harbour Admissions Policy May 2023. pdf
1. Introduction
Please give a description of your child’s needs: (*)
2. Support at Lighthouse
What are your child’s favourite activities at Lighthouse? (please tick those that apply or skip this question)
Are there any activities at Lighthouse that your child is unable, or finds it challenging, to participate in? (please tick those that apply or skip this question)
Sometimes children with special needs find it easier in age groups lower than their actual age (usually by no more than two years below their actual age). If you would like your child to be put in a younger group please select this below. (*)
Regular school year
1 year lower
2 years lower
3 years lower
4 years lower
Does your child receive any form or amount of one-to-one support at school? (*)
As well as hearing from you as the parent/carer of your child, if your child attends a Special Needs school or receives a high level of one-to-one support in their school, it would be really beneficial to speak to your child’s school. Do you give us permission to contact your child’s school to discuss how Lighthouse can best meet your child’s needs? (*)
Sometimes the best way for a child with special or additional needs to access Lighthouse is with their own one-to-one help. Do you think your child would benefit from a 1:1? By selecting ‘yes’ you consent to us providing a 1:1. (*)
Some children with special or additional needs who do not usually require a 1:1 at school or in the community sometimes find Lighthouse more challenging due to the nature of the activities. Therefore, if we feel your child would benefit from a 1:1 at Lighthouse, do you consent to us providing one? (*)
3. Physical development
Vison: (*)
Hearing: (*)
Motor: (*)
Uses: (*)
Detail/other:
4. Communication
Can communicate with others using: (please tick those that apply or skip this question)
Detail/other:
Language spoken at home:
Can understand what others say (*)
Detail/other:
5. Toileting skills
By submitting this form you consent to a Lighthouse volunteer assisting your child in toileting and changing if necessary.
Please tick all that apply
How does your child indicate a need to use the toilet?
6. Eating Habits
Please tick all that apply
Additional Information (please also include details if your child has a restricted diet)
7. Behaviour
please tick those that apply
8. Other information
Please let us know if there is anything else you feel would be useful for us to know about your child:
Doctor's Name (*)
Doctor's phone number (*)
Add another child
Remove following child Second Child
Forename (*)
Surname (*)
Gender (*)
Date of birth (*)
School attended (*)
Church attended (if any)
You can list two children, in the same age group as your child, that you would like your child to be with at Lighthouse. We will do our best to put them in the same Lighthouse group.
Days attending. We would suggest that your child attends all week as we have found that children become upset when they leave early but their friends do not.
Does this child need care during the morning helpers briefing? (*)
Does this child need to be in creche? Only volunteers' children and grandchildren are guaranteed places whilst the volunteer is on site. (*)
Please indicate whether your child is likely to need to use an inhaler or epipen during Lighthouse week.
Is your child taking any medication regularly? (*)
Has your child been immunized against tetanus within the last five years? (*)
Does your child have any other medical conditions we need to be aware of, including allergies? (*)
As part of the Lighthouse programme, we may want to treat your child to a sweet, biscuit or similar, is this acceptable? (*)
Does your child have any special or additional needs? (*)
Lighthouse Additional Needs Questionnaire
Please complete this form if there are any additional needs or circumstances that may impact your child's time at Lighthouse. For example, special educational needs, if they have an EHCP, if they are a looked after child, or anything else you would like us to be aware of. We want to make sure your child has the best experience of Lighthouse so need to ensure we can care for them safely and sensitively.
We will do all we can to accommodate special and additional needs applications but in order to ensure the appropriate support can be available at the Lighthouse you are applying for it is essential that you provide as much information as possible in order to help us best assess whether we can meet the needs of your child.
Lighthouse Safe Harbour (previously Bourne End) is a specialist LH and if you wish to apply for a place for your child please read the attached document first. Lighthouse Safe Harbour Admissions Policy May 2023. pdf
1. Introduction
Please give a description of your child’s needs: (*)
2. Support at Lighthouse
What are your child’s favourite activities at Lighthouse? (please tick those that apply or skip this question)
Are there any activities at Lighthouse that your child is unable, or finds it challenging, to participate in? (please tick those that apply or skip this question)
Sometimes children with special needs find it easier in age groups lower than their actual age (usually by no more than two years below their actual age). If you would like your child to be put in a younger group please select this below. (*)
Regular school year
1 year lower
2 years lower
3 years lower
4 years lower
Does your child receive any form or amount of one-to-one support at school? (*)
As well as hearing from you as the parent/carer of your child, if your child attends a Special Needs school or receives a high level of one-to-one support in their school, it would be really beneficial to speak to your child’s school. Do you give us permission to contact your child’s school to discuss how Lighthouse can best meet your child’s needs? (*)
Sometimes the best way for a child with special or additional needs to access Lighthouse is with their own one-to-one help. Do you think your child would benefit from a 1:1? By selecting ‘yes’ you consent to us providing a 1:1. (*)
Some children with special or additional needs who do not usually require a 1:1 at school or in the community sometimes find Lighthouse more challenging due to the nature of the activities. Therefore, if we feel your child would benefit from a 1:1 at Lighthouse, do you consent to us providing one? (*)
3. Physical development
Vison: (*)
Hearing: (*)
Motor: (*)
Uses: (*)
Detail/other:
4. Communication
Can communicate with others using: (please tick those that apply or skip this question)
Detail/other:
Language spoken at home:
Can understand what others say (*)
Detail/other:
5. Toileting skills
By submitting this form you consent to a Lighthouse volunteer assisting your child in toileting and changing if necessary.
Please tick all that apply
How does your child indicate a need to use the toilet?
6. Eating Habits
Please tick all that apply
Additional Information (please also include details if your child has a restricted diet)
7. Behaviour
please tick those that apply
8. Other information
Please let us know if there is anything else you feel would be useful for us to know about your child:
Doctor's Name (*)
Copy doctor's name from above.
Doctor's phone number (*)
Copy doctor's phone number from above.
Add another child
Remove following child Third Child
Forename (*)
Surname (*)
Gender (*)
Date of birth (*)
School attended (*)
Church attended (if any)
You can list two children, in the same age group as your child, that you would like your child to be with at Lighthouse. We will do our best to put them in the same Lighthouse group.
Days attending. We would suggest that your child attends all week as we have found that children become upset when they leave early but their friends do not.
Does this child need care during the morning helpers briefing? (*)
Does this child need to be in creche? Only volunteers' children and grandchildren are guaranteed places whilst the volunteer is on site. (*)
Please indicate whether your child is likely to need to use an inhaler or epipen during Lighthouse week.
Is your child taking any medication regularly? (*)
Has your child been immunized against tetanus within the last five years? (*)
Does your child have any other medical conditions we need to be aware of, including allergies? (*)
As part of the Lighthouse programme, we may want to treat your child to a sweet, biscuit or similar, is this acceptable? (*)
Does your child have any special or additional needs? (*)
Lighthouse Additional Needs Questionnaire
Please complete this form if there are any additional needs or circumstances that may impact your child's time at Lighthouse. For example, special educational needs, if they have an EHCP, if they are a looked after child, or anything else you would like us to be aware of. We want to make sure your child has the best experience of Lighthouse so need to ensure we can care for them safely and sensitively.
We will do all we can to accommodate special and additional needs applications but in order to ensure the appropriate support can be available at the Lighthouse you are applying for it is essential that you provide as much information as possible in order to help us best assess whether we can meet the needs of your child.
Lighthouse Safe Harbour (previously Bourne End) is a specialist LH and if you wish to apply for a place for your child please read the attached document first. Lighthouse Safe Harbour Admissions Policy May 2023. pdf
1. Introduction
Please give a description of your child’s needs: (*)
2. Support at Lighthouse
What are your child’s favourite activities at Lighthouse? (please tick those that apply or skip this question)
Are there any activities at Lighthouse that your child is unable, or finds it challenging, to participate in? (please tick those that apply or skip this question)
Sometimes children with special needs find it easier in age groups lower than their actual age (usually by no more than two years below their actual age). If you would like your child to be put in a younger group please select this below. (*)
Regular school year
1 year lower
2 years lower
3 years lower
4 years lower
Does your child receive any form or amount of one-to-one support at school? (*)
As well as hearing from you as the parent/carer of your child, if your child attends a Special Needs school or receives a high level of one-to-one support in their school, it would be really beneficial to speak to your child’s school. Do you give us permission to contact your child’s school to discuss how Lighthouse can best meet your child’s needs? (*)
Sometimes the best way for a child with special or additional needs to access Lighthouse is with their own one-to-one help. Do you think your child would benefit from a 1:1? By selecting ‘yes’ you consent to us providing a 1:1. (*)
Some children with special or additional needs who do not usually require a 1:1 at school or in the community sometimes find Lighthouse more challenging due to the nature of the activities. Therefore, if we feel your child would benefit from a 1:1 at Lighthouse, do you consent to us providing one? (*)
3. Physical development
Vison: (*)
Hearing: (*)
Motor: (*)
Uses: (*)
Detail/other:
4. Communication
Can communicate with others using: (please tick those that apply or skip this question)
Detail/other:
Language spoken at home:
Can understand what others say (*)
Detail/other:
5. Toileting skills
By submitting this form you consent to a Lighthouse volunteer assisting your child in toileting and changing if necessary.
Please tick all that apply
How does your child indicate a need to use the toilet?
6. Eating Habits
Please tick all that apply
Additional Information (please also include details if your child has a restricted diet)
7. Behaviour
please tick those that apply
8. Other information
Please let us know if there is anything else you feel would be useful for us to know about your child:
Doctor's Name (*)
Copy doctor's name from above.
Doctor's phone number (*)
Copy doctor's phone number from above.
Add another child
Remove following child Fourth Child
Forename (*)
Surname (*)
Gender (*)
Date of birth (*)
School attended (*)
Church attended (if any)
You can list two children, in the same age group as your child, that you would like your child to be with at Lighthouse. We will do our best to put them in the same Lighthouse group.
Days attending. We would suggest that your child attends all week as we have found that children become upset when they leave early but their friends do not.
Does this child need care during the morning helpers briefing? (*)
Does this child need to be in creche? Only volunteers' children and grandchildren are guaranteed places whilst the volunteer is on site. (*)
Please indicate whether your child is likely to need to use an inhaler or epipen during Lighthouse week.
Is your child taking any medication regularly? (*)
Has your child been immunized against tetanus within the last five years? (*)
Does your child have any other medical conditions we need to be aware of, including allergies? (*)
As part of the Lighthouse programme, we may want to treat your child to a sweet, biscuit or similar, is this acceptable? (*)
Does your child have any special or additional needs? (*)
Lighthouse Additional Needs Questionnaire
Please complete this form if there are any additional needs or circumstances that may impact your child's time at Lighthouse. For example, special educational needs, if they have an EHCP, if they are a looked after child, or anything else you would like us to be aware of. We want to make sure your child has the best experience of Lighthouse so need to ensure we can care for them safely and sensitively.
We will do all we can to accommodate special and additional needs applications but in order to ensure the appropriate support can be available at the Lighthouse you are applying for it is essential that you provide as much information as possible in order to help us best assess whether we can meet the needs of your child.
Lighthouse Safe Harbour (previously Bourne End) is a specialist LH and if you wish to apply for a place for your child please read the attached document first. Lighthouse Safe Harbour Admissions Policy May 2023. pdf
1. Introduction
Please give a description of your child’s needs: (*)
2. Support at Lighthouse
What are your child’s favourite activities at Lighthouse? (please tick those that apply or skip this question)
Are there any activities at Lighthouse that your child is unable, or finds it challenging, to participate in? (please tick those that apply or skip this question)
Sometimes children with special needs find it easier in age groups lower than their actual age (usually by no more than two years below their actual age). If you would like your child to be put in a younger group please select this below. (*)
Regular school year
1 year lower
2 years lower
3 years lower
4 years lower
Does your child receive any form or amount of one-to-one support at school? (*)
As well as hearing from you as the parent/carer of your child, if your child attends a Special Needs school or receives a high level of one-to-one support in their school, it would be really beneficial to speak to your child’s school. Do you give us permission to contact your child’s school to discuss how Lighthouse can best meet your child’s needs? (*)
Sometimes the best way for a child with special or additional needs to access Lighthouse is with their own one-to-one help. Do you think your child would benefit from a 1:1? By selecting ‘yes’ you consent to us providing a 1:1. (*)
Some children with special or additional needs who do not usually require a 1:1 at school or in the community sometimes find Lighthouse more challenging due to the nature of the activities. Therefore, if we feel your child would benefit from a 1:1 at Lighthouse, do you consent to us providing one? (*)
3. Physical development
Vison: (*)
Hearing: (*)
Motor: (*)
Uses: (*)
Detail/other:
4. Communication
Can communicate with others using: (please tick those that apply or skip this question)
Detail/other:
Language spoken at home:
Can understand what others say (*)
Detail/other:
5. Toileting skills
By submitting this form you consent to a Lighthouse volunteer assisting your child in toileting and changing if necessary.
Please tick all that apply
How does your child indicate a need to use the toilet?
6. Eating Habits
Please tick all that apply
Additional Information (please also include details if your child has a restricted diet)
7. Behaviour
please tick those that apply
8. Other information
Please let us know if there is anything else you feel would be useful for us to know about your child:
Doctor's Name (*)
Copy doctor's name from above.
Doctor's phone number (*)
Copy doctor's phone number from above.
Add another child
Remove following child Fifth Child
Forename (*)
Surname (*)
Gender (*)
Date of birth (*)
School attended (*)
Church attended (if any)
You can list two children, in the same age group as your child, that you would like your child to be with at Lighthouse. We will do our best to put them in the same Lighthouse group.
Days attending. We would suggest that your child attends all week as we have found that children become upset when they leave early but their friends do not.
Does this child need care during the morning helpers briefing? (*)
Does this child need to be in creche? Only volunteers' children and grandchildren are guaranteed places whilst the volunteer is on site. (*)
Please indicate whether your child is likely to need to use an inhaler or epipen during Lighthouse week.
Is your child taking any medication regularly? (*)
Has your child been immunized against tetanus within the last five years? (*)
Does your child have any other medical conditions we need to be aware of, including allergies? (*)
As part of the Lighthouse programme, we may want to treat your child to a sweet, biscuit or similar, is this acceptable? (*)
Does your child have any special or additional needs? (*)
Lighthouse Additional Needs Questionnaire
Please complete this form if there are any additional needs or circumstances that may impact your child's time at Lighthouse. For example, special educational needs, if they have an EHCP, if they are a looked after child, or anything else you would like us to be aware of. We want to make sure your child has the best experience of Lighthouse so need to ensure we can care for them safely and sensitively.
We will do all we can to accommodate special and additional needs applications but in order to ensure the appropriate support can be available at the Lighthouse you are applying for it is essential that you provide as much information as possible in order to help us best assess whether we can meet the needs of your child.
Lighthouse Safe Harbour (previously Bourne End) is a specialist LH and if you wish to apply for a place for your child please read the attached document first. Lighthouse Safe Harbour Admissions Policy May 2023. pdf
1. Introduction
Please give a description of your child’s needs: (*)
2. Support at Lighthouse
What are your child’s favourite activities at Lighthouse? (please tick those that apply or skip this question)
Are there any activities at Lighthouse that your child is unable, or finds it challenging, to participate in? (please tick those that apply or skip this question)
Sometimes children with special needs find it easier in age groups lower than their actual age (usually by no more than two years below their actual age). If you would like your child to be put in a younger group please select this below. (*)
Regular school year
1 year lower
2 years lower
3 years lower
4 years lower
Does your child receive any form or amount of one-to-one support at school? (*)
As well as hearing from you as the parent/carer of your child, if your child attends a Special Needs school or receives a high level of one-to-one support in their school, it would be really beneficial to speak to your child’s school. Do you give us permission to contact your child’s school to discuss how Lighthouse can best meet your child’s needs? (*)
Sometimes the best way for a child with special or additional needs to access Lighthouse is with their own one-to-one help. Do you think your child would benefit from a 1:1? By selecting ‘yes’ you consent to us providing a 1:1. (*)
Some children with special or additional needs who do not usually require a 1:1 at school or in the community sometimes find Lighthouse more challenging due to the nature of the activities. Therefore, if we feel your child would benefit from a 1:1 at Lighthouse, do you consent to us providing one? (*)
3. Physical development
Vison: (*)
Hearing: (*)
Motor: (*)
Uses: (*)
Detail/other:
4. Communication
Can communicate with others using: (please tick those that apply or skip this question)
Detail/other:
Language spoken at home:
Can understand what others say (*)
Detail/other:
5. Toileting skills
By submitting this form you consent to a Lighthouse volunteer assisting your child in toileting and changing if necessary.
Please tick all that apply
How does your child indicate a need to use the toilet?
6. Eating Habits
Please tick all that apply
Additional Information (please also include details if your child has a restricted diet)
7. Behaviour
please tick those that apply
8. Other information
Please let us know if there is anything else you feel would be useful for us to know about your child:
Doctor's Name (*)
Copy doctor's name from above.
Doctor's phone number (*)
Copy doctor's phone number from above.
Add another child
Remove following child Sixth Child
Forename (*)
Surname (*)
Gender (*)
Date of birth (*)
School attended (*)
Church attended (if any)
You can list two children, in the same age group as your child, that you would like your child to be with at Lighthouse. We will do our best to put them in the same Lighthouse group.
Days attending. We would suggest that your child attends all week as we have found that children become upset when they leave early but their friends do not.
Does this child need care during the morning helpers briefing? (*)
Does this child need to be in creche? Only volunteers' children and grandchildren are guaranteed places whilst the volunteer is on site. (*)
Please indicate whether your child is likely to need to use an inhaler or epipen during Lighthouse week.
Is your child taking any medication regularly? (*)
Has your child been immunized against tetanus within the last five years? (*)
Does your child have any other medical conditions we need to be aware of, including allergies? (*)
As part of the Lighthouse programme, we may want to treat your child to a sweet, biscuit or similar, is this acceptable? (*)
Does your child have any special or additional needs? (*)
Lighthouse Additional Needs Questionnaire
Please complete this form if there are any additional needs or circumstances that may impact your child's time at Lighthouse. For example, special educational needs, if they have an EHCP, if they are a looked after child, or anything else you would like us to be aware of. We want to make sure your child has the best experience of Lighthouse so need to ensure we can care for them safely and sensitively.
We will do all we can to accommodate special and additional needs applications but in order to ensure the appropriate support can be available at the Lighthouse you are applying for it is essential that you provide as much information as possible in order to help us best assess whether we can meet the needs of your child.
Lighthouse Safe Harbour (previously Bourne End) is a specialist LH and if you wish to apply for a place for your child please read the attached document first. Lighthouse Safe Harbour Admissions Policy May 2023. pdf
1. Introduction
Please give a description of your child’s needs: (*)
2. Support at Lighthouse
What are your child’s favourite activities at Lighthouse? (please tick those that apply or skip this question)
Are there any activities at Lighthouse that your child is unable, or finds it challenging, to participate in? (please tick those that apply or skip this question)
Sometimes children with special needs find it easier in age groups lower than their actual age (usually by no more than two years below their actual age). If you would like your child to be put in a younger group please select this below. (*)
Regular school year
1 year lower
2 years lower
3 years lower
4 years lower
Does your child receive any form or amount of one-to-one support at school? (*)
As well as hearing from you as the parent/carer of your child, if your child attends a Special Needs school or receives a high level of one-to-one support in their school, it would be really beneficial to speak to your child’s school. Do you give us permission to contact your child’s school to discuss how Lighthouse can best meet your child’s needs? (*)
Sometimes the best way for a child with special or additional needs to access Lighthouse is with their own one-to-one help. Do you think your child would benefit from a 1:1? By selecting ‘yes’ you consent to us providing a 1:1. (*)
Some children with special or additional needs who do not usually require a 1:1 at school or in the community sometimes find Lighthouse more challenging due to the nature of the activities. Therefore, if we feel your child would benefit from a 1:1 at Lighthouse, do you consent to us providing one? (*)
3. Physical development
Vison: (*)
Hearing: (*)
Motor: (*)
Uses: (*)
Detail/other:
4. Communication
Can communicate with others using: (please tick those that apply or skip this question)
Detail/other:
Language spoken at home:
Can understand what others say (*)
Detail/other:
5. Toileting skills
By submitting this form you consent to a Lighthouse volunteer assisting your child in toileting and changing if necessary.
Please tick all that apply
How does your child indicate a need to use the toilet?
6. Eating Habits
Please tick all that apply
Additional Information (please also include details if your child has a restricted diet)
7. Behaviour
please tick those that apply
8. Other information
Please let us know if there is anything else you feel would be useful for us to know about your child:
Doctor's Name (*)
Copy doctor's name from above.
Doctor's phone number (*)
Copy doctor's phone number from above.
Add another child
Remove following child Seventh Child
Forename (*)
Surname (*)
Gender (*)
Date of birth (*)
School attended (*)
Church attended (if any)
You can list two children, in the same age group as your child, that you would like your child to be with at Lighthouse. We will do our best to put them in the same Lighthouse group.
Days attending. We would suggest that your child attends all week as we have found that children become upset when they leave early but their friends do not.
Does this child need care during the morning helpers briefing? (*)
Does this child need to be in creche? Only volunteers' children and grandchildren are guaranteed places whilst the volunteer is on site. (*)
Please indicate whether your child is likely to need to use an inhaler or epipen during Lighthouse week.
Is your child taking any medication regularly? (*)
Has your child been immunized against tetanus within the last five years? (*)
Does your child have any other medical conditions we need to be aware of, including allergies? (*)
As part of the Lighthouse programme, we may want to treat your child to a sweet, biscuit or similar, is this acceptable? (*)
Does your child have any special or additional needs? (*)
Lighthouse Additional Needs Questionnaire
Please complete this form if there are any additional needs or circumstances that may impact your child's time at Lighthouse. For example, special educational needs, if they have an EHCP, if they are a looked after child, or anything else you would like us to be aware of. We want to make sure your child has the best experience of Lighthouse so need to ensure we can care for them safely and sensitively.
We will do all we can to accommodate special and additional needs applications but in order to ensure the appropriate support can be available at the Lighthouse you are applying for it is essential that you provide as much information as possible in order to help us best assess whether we can meet the needs of your child.
Lighthouse Safe Harbour (previously Bourne End) is a specialist LH and if you wish to apply for a place for your child please read the attached document first. Lighthouse Safe Harbour Admissions Policy May 2023. pdf
1. Introduction
Please give a description of your child’s needs: (*)
2. Support at Lighthouse
What are your child’s favourite activities at Lighthouse? (please tick those that apply or skip this question)
Are there any activities at Lighthouse that your child is unable, or finds it challenging, to participate in? (please tick those that apply or skip this question)
Sometimes children with special needs find it easier in age groups lower than their actual age (usually by no more than two years below their actual age). If you would like your child to be put in a younger group please select this below. (*)
Regular school year
1 year lower
2 years lower
3 years lower
4 years lower
Does your child receive any form or amount of one-to-one support at school? (*)
As well as hearing from you as the parent/carer of your child, if your child attends a Special Needs school or receives a high level of one-to-one support in their school, it would be really beneficial to speak to your child’s school. Do you give us permission to contact your child’s school to discuss how Lighthouse can best meet your child’s needs? (*)
Sometimes the best way for a child with special or additional needs to access Lighthouse is with their own one-to-one help. Do you think your child would benefit from a 1:1? By selecting ‘yes’ you consent to us providing a 1:1. (*)
Some children with special or additional needs who do not usually require a 1:1 at school or in the community sometimes find Lighthouse more challenging due to the nature of the activities. Therefore, if we feel your child would benefit from a 1:1 at Lighthouse, do you consent to us providing one? (*)
3. Physical development
Vison: (*)
Hearing: (*)
Motor: (*)
Uses: (*)
Detail/other:
4. Communication
Can communicate with others using: (please tick those that apply or skip this question)
Detail/other:
Language spoken at home:
Can understand what others say (*)
Detail/other:
5. Toileting skills
By submitting this form you consent to a Lighthouse volunteer assisting your child in toileting and changing if necessary.
Please tick all that apply
How does your child indicate a need to use the toilet?
6. Eating Habits
Please tick all that apply
Additional Information (please also include details if your child has a restricted diet)
7. Behaviour
please tick those that apply
8. Other information
Please let us know if there is anything else you feel would be useful for us to know about your child:
Doctor's Name (*)
Copy doctor's name from above.
Doctor's phone number (*)
Copy doctor's phone number from above.
I agree to my child(ren) attending Lighthouse 2023 and I give permission to Lighthouse to give or authorise medical treatment if considered necessary. I agree to my children being cared for in accordance with the policies available on the Lighthouse Central website, namely Safeguarding, Child Behaviour Management and Heath & Safety.
I will not remove my children before the end of the day without notifying the Age Group Leader.
I acknowledge that video and photographs may be taken during Lighthouse week and used in publicity material. If I do not want my child to appear in any such materials I will make the Lighthouse aware of this in writing.
By submitting this form you are confirming that you agree to the above Parental Consent statement.
By submitting this form you are confirming that you agree to Lighthouse holding the details supplied on this form on a database for a maximum period of 2 years from the date of signature for the purposes of Lighthouse administration. The details will be kept confidential and restricted to Lighthouse trustees and individuals nominated by them. Our Data Privacy Notice can be seen below.
Please only contact us if it is essential by emailing us at admin@lighthousecentral.org. Thank you for your support of Lighthouse.
