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 * Please enter one of: Nursery, Reception, Year 1
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 * Please enter in DD/MM/YYYY format
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 * Please list any that apply: asthma; any reaction to sticking plasters; any reaction to latex rubber; any allergies. If none, please write 'none of the above'.

I give permission for my child to take part in the School Fluoride Varnish programme. A dental professional will have a quick look in my child’s mouth and apply fluoride varnish this school year. I confirm that I have read and understood all the information above, and I understand that my child’s information may be shared with the school to help support access to dental care.

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