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If you’re under 18, please ask a parent or guardian to complete this with you as we will need their details and permission to get in touch.
The name of your parent or guardian (if you are under 18).
for more information about how we manage your data.
We'd like to be able to use your comments to support the work of our hospital and for fundraising activities. We may use your submission to provide an anonymous quote to promote the scheme in our communications. In this instance, we may contact you to ask if you are happy to be named.
I am happy for my name to be shared with the person or team I have nominated