Covid - 19

Consent Form

Name of Child:

Date of Birth:

Telephone:

E-Mail:

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

Have you or your child returned from any of the countries currently listed on the governments quarantine list in the past 14 days

Have you or your child been in contact with anyone with Covid - 19 symptoms

Please provide us with details of any health problems or allergies that your child has