First Steps Academy Creche & Montessori

COVID-19 Declaration Form

Child's Full Name:

Parent/Guardian Name:

Email:

Phone:

Does you/your child have symptoms of cough, fever, high temperature, sore throat, runny nose, breathlessness or flu like symptoms now or in the past 14 days?

Has you/your child been diagnosed with confirmed or suspected COVID-19 infection in the last 14 days?

Is you/your child a close contact of a person who is a confirmed or suspected case of COVID-19 in the past 14 days or has you/your child been advised by a doctor or HSE Public Health to self-isolate in the past 14 days?

Do you have any further relevant information that may affect your child, relating to COVID-19, not included in the above, which may need to be considered to allow your child's safe return to our setting?

Any Further Information (Optional):

COVID-19 Declaration Form

Get in touchinfo@firststepsacademy.ie01 - 555 5158

Get in touch
info@firststepsacademy.ie
01 - 555 5158