Ian Ramsey CE Academy

PUPIL DETAILS

Name of Pupil:*

First Last

Year Group:*

Class:*

Is your child vulnerable?

KEY WORKER DETAILS

Please complete details for each applicable parent below

Do you consider one or both parents/carers to be a Key Worker in line with government guidance:*

Both parents Key workers
One parent Key worker
Lone single parent Key worker

Link to guidance can be found at the top of this page.

Parent/Carer 1 Name:*

First Last

Parent Carer 1 Address:*

Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country

Parent Carer 1 Contact Telephone:*

Parent/Carer 1 Job Title:*

(please specify if full or part time and specify school days worked)

Please identify your specific role (e.g area of NHS)*

Key Worker Group:*

Please upload supporting evidence*

Parent/Carer 2 (if applicable)

Parent/Carer 2 Name:

First Last

Parent Carer 2 Address:

Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country

Parent Carer 2 Contact Telephone:

Parent/Carer 2 Job Title:

(please specify if full or part time and specify school days worked)

Please identify your specific role (e.g area of NHS)

Key Worker Group:

CHILDCARE REQUIREMENTS (Are you part time?)

Please indicate at which times your child will need to remain in school.

Monday

AM
PM
Both

Tuesday

AM
PM
Both

Wednesday

AM
PM
Both

Thursday

AM
PM
Both

Friday

AM
PM
Both

Finally...

What is your relationship to the pupil named above?*

Email

This field is for validation purposes and should be left unchanged.

Key Worker Form

PUPIL DETAILS

KEY WORKER DETAILS

Parent/Carer 2 (if applicable)

CHILDCARE REQUIREMENTS (Are you part time?)

Finally...