Covid-19 Reporting Form

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Dear Parents and Carers,

If your child or any member of your household or 'Christmas Bubble' requires a Covid-19 test and subsequently records a positive result over the Christmas holiday, please inform us using the Google Form below.

This information will enable us to keep track of cases in the Nursery population and monitor return dates in January.

Please be assured that this form will remain confidential has been designed to require minimal information from you.

Information regarding any cases in Nursery bubbles of children/staff during the first few days of the holidays will be shared with you via Famly.

Your willingness to share this information will help keep the Nursery as safe as possible for all of our children, families and staff and enable Nursery administration to function as smoothly as possible on our re-opening.

Thank you for your support and assistance.

Your name *

My Child's full name is *

My Child is in *

Baby Room

Toddler Room

Pre-School

The positive test result in my household relates to *

My Child

a member of our household (including your Christmas bubble)

The symptoms experienced are *

The first day of symptoms was *

YYYY

The POSITIVE test date was *

YYYY

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