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* 1. Your email address

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* 2. Please state your full name

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* 3. Parent 1: I am a 'Key Worker' (Please select role):

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* 4. Parent 2: I am a 'Key Worker' (Please select role):

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* 5. Will you require childcare provision within the following periods? (Please tick all that apply).

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* 6. How many children require child care?

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* 7. Do you require a school meal to be provided?

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* 8. If you require provision, please state your best estimate of days required (Please tick all that apply).

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* 9. Will you be likely to require before or after school club provision?  NB we cannot guarantee this service at this time

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