Parent/carer registration form – new user Email Thank you for choosing to register with ADHD Embrace. The information captured in this registration will allow us to better serve you and will also support the vital work we do as a charity. It will help us demonstrate the need for our services and raise money to support our ADHD community. The data is captured in-line with our privacy policy. Personal details First name * Last name * Email address * Confirm Email address * Phone number * Your email address will also be your username to login to our website. Password * Confirm Password Address line 1 * Address line 2 London council borough * Not in London borough Richmond upon Thames Kingston upon Thames Barking and Dagenham Barnet Bexley Brent Bromley Camden Croydon Ealing Enfield Greenwich Hackney Hammersmith and Fulham Haringey Harrow Havering Hillingdon Hounslow Islington Kensington and Chelsea Lambeth Lewisham Merton Newham Redbridge Southwark Sutton Tower Hamlets Waltham Forest Wandsworth Westminster If in London, please select your borough County council * Not in the UK Greater London Bath and North East Somerset Bedfordshire Berkshire Bristol Aberdeenshire Angus Antrim Argyll & Bute Ayrshire Banffshire Armagh Berwickshire Blaenau Gwent Borders Bridgend Buckinghamshire Caerphilly Caithness Cambridgeshire Cardiff Carmarthenshire Ceredigion Cheshire Clackmannanshire Conwy Cornwall County Durham Cumbria Denbighshire Derbyshire Devon Down Dumfries & Galloway Dunbartonshire East Ayrshire East Dunbartonshire East Lothian East Renfrewshire East Riding of Yorkshire East Sussex Essex Fermanagh Fife Flintshire Gloucestershire Greater Manchester Gwynedd Hampshire Herefordshire Hertfordshire Highland Inverclyde Isle of Anglesey Isle of Wight Isles of Scilly Kent Kincardineshire Lancashire Leicestershire Lincolnshire Londonderry Merseyside Merthyr Tydfil Midlothian Monmouthshire Moray Neath Port Talbot Newport Norfolk North Ayrshire North Lanarkshire North Somerset North Yorkshire Northamptonshire Northumberland Nottinghamshire Orkney Oxfordshire Pembrokeshire Perth & KInross Powy Renfrewshire Rhondda Cynon Taff Rutland Shetland Shropshire Somerset South Ayrshire South Gloucestershire South Lanarkshire South Yorkshire Staffordshire Stirlingshire Suffolk Surrey Swansea Torfaen Tyne & Wear Tyrone Vale of Glamorgan Warwickshire West Dunbartonshire West Lothian West Midlands West Sussex West Yorkshire Western Isles Wiltshire Worcestershire Wrexham If outside of London, please select your area Full postcode * Please provide your full postcode (with a space), this is required for our funders Country * United Kingdom Afghanistan Åland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire, Saint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo, Republic of the Congo, The Democratic Republic of the Cook Islands Costa Rica Côte d’Ivoire Croatia Cuba Curaçao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Eswatini Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See (Vatican City State) Honduras Hong Kong Hungary Iceland India Indonesia Iran, Islamic Republic of Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Korea, Democratic People's Republic of Korea, Republic of Kosovo Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia, Federated States of Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Macedonia Northern Mariana Islands Norway Oman Pakistan Palau Palestine, State of Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda Saint Barthélemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Martin (French part) Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Serbia and Montenegro Seychelles Sierra Leone Singapore Sint Maarten (Dutch Part) Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Sweden Switzerland Syrian Arab Republic Taiwan Tajikistan Tanzania, United Republic of Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Venezuela Viet Nam Virgin Islands, British Virgin Islands, U.S. Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe If not in the UK, please select your country How many children do you have in total? * How many of your children have ADHD? * What is the total number of people (including adults) in your household? * Are you registered with ADHD Embrace Parents’ Facebook Forum? Yes No Details of child 1 with or suspected with ADHD First Name * Last Name * Month of birth * January February March April May June July August September October November December Year of birth * 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 Other Gender Assigned at Birth * Female Male Has your child been diagnosed with ADHD? * Yes No Age when diagnosed with ADHD 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Other Does your child have any other conditions? * Yes Suspected No Is your child in school? In School Homeschooled Excluded Past school age Do you need to fill in details for a second child with ADHD? YesNo I agree to my data being stored as per being stored inline with ADHD Embrace's Privacy Policy * Subscribe to our newsletter I would like to receive the fortnightly newsletter Thank you for completing the form. Don't forget to click the 'submit form' button below to complete registration. Thank you!
