Child Health Questionnaire and Mental Well-being Support
Dear Parent,

Before your child returns to nursery we want you to answer some questions and sign the declaration below. We have put these measures in place to help prevent the spread of Coronavirus (COVID- 19) and protect the health of others.

Thank you for your understanding and cooperation
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Child's Name *
Child Date of Birth *
MM
/
DD
/
YYYY
Parent/Carer's Name *
Primary Parent/Carer's Email *
Primary Parent/Carer's Moblie *
Further Emergency Contacts with Relationship to Child and Contact Information
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