Covid19 Consent Form
Covid - 19
We look forward to hearing from you.
Please fill out all required fields.
Name of Child *
Date of Birth *
Have you or your child returned from any of the countries currently listed on the governments quarantine list in the past 14 days *
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 *
Please provide us with details of any health problems or allergies that your child has *
Have you or your child been in contact with anyone with Covid - 19 symptoms *
* required fields
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