Fill out the form below to let us know if your child will be attending a Smartkidz setting with an existing injury. Existing Injury Name of child * Name of child First First Last Last Today's date * Date injury occurred * Name of Smartkidz setting * GirtonHaddenhamMayfieldRidgefieldCherry HintonWarboys Name of person informing the setting * Name of person informing the setting First First Last Last Relationship of person to the child * How did the injury happen? * Are there any visible marks, bruises or injuries (describe size, shape, colour and location)? * Was treatment given? * Was medical advice sought (include GP surgery or hospital details)? * Additional information or comments Signature of person providing the information * Clear If you are human, leave this field blank. Submit Start Over