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* 1. In order for us to support your child on their return to school please tell us about any significant incidents that will have affected your child/family/community during Covid 19. This may include bereavement, serious illness, financial difficulty, loss of a beloved pet, family breakdown, or anything else that you feel has affected your child significantly.

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* 2. How has your child coped with the lockdown and absence from school? Please choose the one that fits best...

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* 3. Please use this space to tell us specifically about what your child's concerns/worries/anxieties have been...

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* 4. Please indicate by choosing the best box how your child is feeling about coming back to school...

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* 5. Please use this space to tell us your child's specific worries or concerns about returning to school.

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* 6. Please use this space to tell us about any other relevant concerns that you have around your child returning to school or the impact that lock down may have had on their well being.

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* 7. Thank you for providing is with this information which will be very useful in helping us prepare appropriate support for your child on their return to school.

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* 8. What is your child's name?  and what year group are they in?

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