* 1. What is your child's name?

* 2. What class and school is your child in?

* 3. Please give the best two contact telephone numbers for you between 15.45 - 17.30 on a Thursday. 
Ideally this will be two different people who have parental responsibility for the child.

* 4. My child has the following medical condition.

* 5. My child has allergies to the following things