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Medical or Dental Appointment Notification Form
Please use this form to notify Someries Infant School and Early Childhood Education Centre of your child's medical or dental appointments.
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Your child's name
*
This field is required.
First Name
Last Name
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2
Your child's class
*
This field is required.
Please Select
Windsor
Lancaster
Warwick
Gosford
Tintagel
Edinburgh
Durham
Cardiff
York
The Compass
The Link
The Lighthouse
Please Select
Please Select
Windsor
Lancaster
Warwick
Gosford
Tintagel
Edinburgh
Durham
Cardiff
York
The Compass
The Link
The Lighthouse
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3
Date of medical or dental appointment
*
This field is required.
.
Date
Day
Month
Year
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4
What time is your child's appointment?
*
This field is required.
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Minutes
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5
Will your child attend school before their appointment?
*
This field is required.
YES
NO
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6
What time will your child be collected from school?
*
This field is required.
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7
Will your child return to school after their appointment?
*
This field is required.
YES
NO
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8
What time will your child return to school after their appointment?
*
This field is required.
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9
Purpose of medical or dental appointment
*
This field is required.
Please provide as much information as you can relating to your child's absence.
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10
Please upload a copy of the appointment confirmation
This can be a document, a photograph of the appointment confirmation or a screenshot of an SMS message confirming the appointment
Drag and drop files here
Select files to upload
Max. file size
: 10.6MB
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11
Your name
*
This field is required.
First Name
Last Name
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12
Your contact telephone number
*
This field is required.
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13
Your email address
*
This field is required.
example@example.com
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14
Please verify this submission.
*
This field is required.
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