PARENTCONSENTLETTER_COMBO Parental Consent for National Dental Programme - 2023 to 2024 Parental Consent for National Dental Programme - 2023 to 2024 Please read the information on the left before completing this form. Child’s Name * Child’s Date Of Birth * Gender * Girl Boy Dropdown * WHITE - English/Welsh/Scottish/Northern Irish/BritishWHITE - IrishWHITE - Gypsy or Irish TravellerWHITE - RomaWHITE -Any other White backgroundMIXED or Multiple - White and Black CaribbeanMIXED or Multiple - White and Black AfricanMIXED or Multiple - White AsianMIXED or Multiple - Any other mixed/Multiple ethnic backgroundASIAN/ASIAN BRITISH - IndianASIAN/ASIAN BRITISH - PakistaniASIAN/ASIAN BRITISH - BangladeshiASIAN/ASIAN BRITISH - ChineseASIAN/ASIAN BRITISH - Any other Asian backgroundBLACK - AfricanBLACK - Caribbean D2 F Any other Black/African/ Caribbean backgroundBLACK - Any other Black/African/Caribbean backgroundOTHER - ArabDO NOT WANT DISCLOSE Child’s Home Postcode * Name of parent or person with parental responsibility * I have read and understood the information for parents and persons with parental responsibility * Yes I agree to my child having a dental check as part of the national dental programme 2023 to 2024 * Yes No Parent Signature * signature keyboard Clear Date * Submit If you are human, leave this field blank. Δ
