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Queen’s Inclosure Primary School

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HEALTH DECLARATION (Open in Chrome)

Please complete this declaration if your child is returning to school after an absence of greater than 7 calendar days.

Has anyone in your household ever experienced any symptoms of COVID-19?*
If your child has contact with a parent living in a separate household, has anyone in that household ever experienced any symptoms of COVID-19?*

If you have answered 'Yes' to either of these questions, please complete the Additional Information section below. Otherwise , please proceed to the Declaration at the end of the form.

I declare that the above information is true. I will advise the school immediately that anyone in my household, or a connected household, should develop any symptoms of COVID-19.*