Data Privacy and Information Sharing Statement
I confirm that following discussion with school/setting staff, I agree to the involvement of Children’s
I have had the reasons for this service request explained to me, I understand the reasons for the
request and understand that my information will be shared with Children’s Services as part of this
request. I agree to the request and give consent for Children’s Services to work with my child (or
me as the named young person).
I understand that working with my child (or me) will necessitate the sharing of information between
relevant services, in the interests of providing a service to me or my child. I understand that the
information contained within this form will be recorded on a Hertfordshire County Council case
management system and other services may be able to see the content on this form. Hertfordshire
County Council is the Data Controller for this information and its lawful basis for processing is to
fulfil its duties in respect of special educational needs provision (public task).
Information on you or your child/young person will be held until 35 years after the date of birth.
Full information on your rights in respect of personal data held about you can be found at
Please tick the relevant services you do not wish information to be shared with, however please
note there may be circumstances where we have to share your details without your consent e.g. if
we believe it is the best interests of a child:
National Health Services partners (Paediatricians, Speech & Language
Therapists, CAMHS etc)
Child/young person Parent/carer
Note: If the young person is the age of 16 or over and has mental capacity, they must provide a
signature (and a parent signature is not required).