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* 1. Are you employed in one of the following key worker roles?

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* 2. Are you employed in a key worker role that is not listed above (please add below)

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* 3. Do you need your child to still come to school during the shut down so that you can carry out your job?

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* 4. Your full name

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* 5. Name of your child/children

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* 6. Any other comments

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