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Coronavirus (COVID) Health Questionnaire
Questions
Have you or your children travelled internationally and returned to the UK, in the last 14 days?
Yes
No
Have you or your children knowingly been in contact with any person who has returned from overseas in the last 14 days?
Yes
No
Have you or your child/ren been exposed to a confirmed case of Coronavirus?
Yes
No
Have you or your child/ren had contact with person(s) with flu-like symptoms?
Yes
No
Do you have any of the following symptoms? (Please tick all that apply)
Fever
Continuous cough
Sore throat
Muscle and/or joint pain
Running nose
Loss or change to your sense of smell or taste
Stuffy nose
Fatigue
Diarrhoea
Vomiting
Breathing difficulty
No symptoms
If you answered "YES" to any of the above questions or symptoms you will be unable to participate in the lesson today.
Declaration
I declare that all of the information given in this form is true and correct:
Child/rens name/s
Parents' name
Contact Number
Address
Your Name
Submit