Select English Afar Abkhazian Afrikaans Amharic Arabic Assamese Aymara Azerbaijani Bashkir Belarusian Bulgarian Bihari Bislama Bengali/Bangla Tibetan Breton Catalan Corsican Czech Welsh Danish German Bhutani Greek Esperanto Spanish Estonian Basque Persian Finnish Fiji Faeroese French Frisian Irish Scots/Gaelic Galician Guarani Gujarati Hausa Hindi Croatian Hungarian Armenian Interlingua Interlingue Inupiak Indonesian Icelandic Italian Hebrew Japanese Yiddish Javanese Georgian Kazakh Greenlandic Cambodian Kannada Korean Kashmiri Kurdish Kirghiz Latin Lingala Laothian Lithuanian Latvian/Lettish Malagasy Maori Macedonian Malayalam Mongolian Moldavian Marathi Malay Maltese Burmese Nauru Nepali Dutch Norwegian Occitan (Afan)/Oromoor/Oriya Punjabi Polish Pashto/Pushto Portuguese Quechua Rhaeto-Romance Kirundi Romanian Russian Kinyarwanda Sanskrit Sindhi Sangro Serbo-Croatian Singhalese Slovak Slovenian Samoan Shona Somali Albanian Serbian Siswati Sesotho Sundanese Swedish Swahili Tamil Telugu Tajik Thai Tigrinya Turkmen Tagalog Setswana Tonga Turkish Tsonga Tatar Twi Ukrainian Urdu Uzbek Vietnamese Volapuk Wolof Xhosa Yoruba Chinese Zulu
Select None Atheist Agnostic Bahai Buddhist Chinese folk-religionists
Christian Confucianist Daoist Ethnoreligionist Hindu Jainism Jewish
Muslim New Religionists Shintoist Sikh Spiritists Zoroastrians
Select None Cotton wool Dairy Dust Mites Eggs Insect Bites Latex Nuts (in general) Peanuts Penicillin Pollen Shellfish Fruit Wasps Bees Plasters Milk Wheat Soap
Select None Asthma Autism ADHD Cerebal Palsy Cleft Lip Cleft lip- special drink container Cystic Fibrosis Diabetes Diphtheria Down Syndrome Eczema Epilepsy Eye Problems – long /short sighted Febrile convulsions Foetal Alcohol syndrome Global development delay Grommets Heart Condition Hearing impairment Hypermobility Kidney problems Requires a wheelchair in an evacuation Slight / Speech problems Speech / language development Tetanus Visual Impairment Wears splints
Does your child fall in the vulnerable category for shielding?
Has anyone in your household displayed symptoms or tested positive for Covid-19?
If yes please confirm the required isolation period has been completed?
As a household have you observed social distancing with other outside of your household?
* My Child’s Care Plan
Care Plan required for:
Is support provided by any other agencies or individuals?: