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Name (Yours, not your child's)*

Your email address*

Please re-enter your email address*

Your phone number*

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Here is what's left for appointments; please don't ask for something that isn't listed!

Preferred Day:* Availability is changing all the time, so please be understanding...

Preferred Date:*

Preferred Time (check the opening times please):*

Number of children, their names & ages*

Current shoe size/ sizes*

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Details of what you need:

School Shoes - Please choose ONE category:

I would like BLACK leather shoes
I would like NAVY leather shoes
I would like black trainers INSTEAD of leather shoes

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School P.E. Trainers - Please choose ONE category:

I would like white
I would like black

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Trainers for school or home

I would like any colour

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Any other footwear required:

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Expected total number of pairs*

Does your child/children wear orthotics?*

Yes
No

Any other relevant information

STOP!

All done? Great!

You may now submit your request. If a confirmation message does NOT appear on the screen there is something wrong - please check & submit again!

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