Parental Declaration Form

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Clonbonny National School
Parental Declaration Form

This form will need to be filled in again when children are returning to Clonbonny NS after any absence or school break .

* Indicates required field

Name *

First

Last

Class *

Teacher *

1. My child is currently displaying symptoms of Covid- 19 ? *

Yes No

2.My child is awaiting results of a Covid -19 test at the moment ? *

Yes No

3.My child has engaged in foreign travel in the last 14 days? *

Yes No

4.My child has been identified as a close contact of a confirmed case? *

Yes No

5.My child has been advised by a doctor to self -isolate? *

Yes No

6.My child has been advised to restrict movements ? *

Yes No

7.My child is residing with someone who is displaying symptoms of the virus? *

Yes No

PLEASE ENTER PARENT OR LEGAL GUARDIANS NAME *

First

Last

Declaration
I have no reason to believe that my child has an infectious disease and that I have followed all medical and public health guidance with respect to the exclusion of my child form educational facilities.

Submit

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Home
About Us
- Contact us
Useful websites
Well-Being Questionnaire
Classroom News
Sports
Polytunnel
Parents
Policies
Flags
- Green Flag
  - Active FLag
  - Digital Flag
Archive
Teacher Resources

Clonbonny National School Parental Declaration Form

Clonbonny National School
Parental Declaration Form