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Child's name

What year is your child in?

What level is you child working at?

What school does your child go to?

Parent/guardian name

Parent/guardian email

Parent/guardian phone number

Does your child have any special educational needs?

No

Autism Spectrum Condition

ADHD

Anxiety

Auditory processing disorder

Dyslexia

Dyspraxia

Dysgraphia

Dyscalculia

other not listed please specify in message box below

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