Deaf Role Model request form

Before we can arrange for you to meet with a Deaf Role Model there are a few questions that we need to ask you.

Are you a parent/guardian of a deaf child or young deaf person?

Please select the area that you live in

Title

Full name *

Address *

Post code *

Telephone *

Will you be using voice or minicom?

Mobile

Email *

Deaf child or young person's name *

Date of birth

Gender

What is the best way to contact you?

I do not want to receive any information from NDCS about its services and activities. Your data will be held on the NDCS database. We use it to send you information about our NDCS services and activities. This data will not be shared with any other party without your explicit permission. As NDCS relies mostly on voluntary income we will contact you from time to time to give you the opportunity to support our work. If you do not want to be contacted in future please indicate clearly by ticking the box above. If you would prefer not to receive emails or phone calls form NDCS about its services and activities please tick the relevant boxes below.

I do not want NDCS to email me

I do not want NDCS to telephone me

Your local deaf children’s society. NDCS also works with independent deaf children’s societies. If you would like us to share your contact details with your nearest society so they can advise you of activities in their area please tick the box above.

Deaf Role Model request form

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