Description
Description
07941 810227

Covid - 19
Consent Form

Telephone
E-Mail
07941 810227
01923 267960
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Name of Child:
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Date of Birth:
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Telephone:
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E-Mail:
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Has your child or anyone within your household has any of the following symptoms : ........A TEMPERATURE OF 37.8 OR ABOVE. A COUGH/ SHORTNESS OF BREATH/ LOSS OF TASTE OR SMELL
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Have you or your child returned from any of the countries currently listed on the governments quarantine list in the past 14 days
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denotes a compulsory field.
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Have you or your child been in contact with anyone with Covid - 19 symptoms
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Please provide us with details of any health problems or allergies that your child has
covid
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