Voices of Dyslexia Parent/Carer Consent Form

Please complete the following form for any minor prior to completing a video for Voices of Dyslexia.

Child's Name(Required)

Parent / Carer's Name(Required)

First Last

Parent / Carer's Email(Required)

Assessment Request Form

Please complete this form and I’ll get in touch with you as soon as possible.

Name

Email(Required)

Phone(Required)

Which best describes your relationship with the child?(Required)

Child's age(Required)

Child's School

Your Message(Required)

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