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Key Worker Declaration Form
In the event of a further lockdown, and the required closure of George Fentham Endowed School to all children EXCEPT those classified as 'Vulnerable' or of 'Key Workers', we would ask you to complete the below form to request a place for your child.
Please
ONLY
fill in this form if you meet
ALL
3 of the following criteria:
1. You believe you come under one of the defined categories of "key worker" listed below
AND
2. There is no other non-key worker parent/partner in the household able to supervise your child at home (e.g: you are a single parent and/or both parents are key workers)
AND
3. You require your child (or children) to be at school during this lockdown period.
George Fentham School will be providing
care
, for those children who qualify, from 8.45am to 3.30pm.
For any parents requiring care outside of these hours, please contact The BASE on
01675 443913
or go to;
www.thebasechildcare.co.uk
PLEASE COMPLETE ALL BOXES BEFORE SUBMITTING THE FORM.
*
Indicates required field
Name of Parent 1
*
First
Last
Name of Parent 2
*
First
Last
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Email
*
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Email
*
Phone Number
*
Phone Number
*
Please identify whether you are a single parent.
*
Yes
No
Key Worker Category
Key Worker Category
Please select, from the list below, which of the Government's stated Key Worker categories you come under.
*
Health & Social Care Services
Key Public Services
Education & Childcare
Local & National Government
Food & Other necessary goods
Public Safety & National Security
Transport
Utilities, Communication & Financial Services
Job Title
*
Please select, from the list below, which of the Government's stated Key Worker categories you come under.
*
Health & Social Care Services
Key Public Services
Education & Childcare
Local & National Government
Food & other necessary goods
Public Safety & National Security
Transport
Utilities, Communication & Financial Services
None
Job Title
*
Employer Name
*
Employer Name
*
Employer Address
*
Line 1
Line 2
City
State
Zip Code
Country
Employer Address
*
Line 1
Line 2
City
State
Zip Code
Country
Phone Number
*
Phone Number
*
First Child's Name
*
Child's Year Group/Age
*
Second Child's name
*
Child's Year Group/Age
*
Third Child's Name
*
Child's Year Group/Age
*
IMPORTANT:
Any child/ren offered a place will REQUIRE a packed lunch, unless they receive free school meals, as there will be no catering facilities on-site.
Please tell us any additional information in support of your request.
*
Submit