Please complete this form on attending a face-to-face session with Mallard Days Educational Services
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Name of student *
Name of parent / guardian
Address *
Contact telephone number *
Contact email address
Date and time of session *
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Time
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I confirm that neither I, nor anyone accompanying me, has been required to self-isolate by current UK government guidance. *
I confirm that if I, or anyone accompanying me is contacted as part of coronavirus contract tracing, I will inform Mallard Days as soon as practicable. *
I confirm that if I, or anyone accompanying me, starts suffering from coronavirus symptoms or receives a positive coronavirus test, I will inform Mallard Days as soon as practicable. *
I consent for my data to be held for the purposes of coronavirus contact tracing, and that this data may be disclosed to NHS Track and Trace or other authorities for the purpose of disease control. *
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This form was created inside of Mallard Days Enterprises.