Southfields Academy Critical Workers Form

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This form is to be completed by the parent or legal guardian of the pupil. This will cover the period from Monday 18th January to Friday 12th February.

Please only complete this form if you are a critical worker and have no other childcare available. You should only send your child to the Academy if they cannot be safely cared for by someone at home. Please note - where there are two carers in the home BOTH are required to be critical workers and evidence will need to be provided. If you or another another family member is working from home, your child/ren should remain at home.

Name of Pupil *

Year Group of Pupil *

Tutor Group *

I require my child attend on

Yes

Monday

Tuesday

Wednesday

Thursday

Friday

Please supply a name and contact number in case of exceptional circumstances *

Please provide your email address *

Please provide your phone number *

I work in: *

Health and Social Care

Education and Childcare

Key Public Services

Local and National Government

Food and other necessary goods

Public Safety and National Security

Transport

Utilities, Communications and Financial Services

*Please do not be offended if we ask for verification of your role.

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