HSE Return to Educational Facility Parental Declaration Form

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HSE Return to Educational Facility Parental Declaration Form

This form is to be used when children are returning to the setting after any absence

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* Indicates required question

Child's Name *

Your answer

Parent's/Guardian's Name *

Your answer

Name of Educational Setting *

Your answer

Class *

Choose

Junior Infants

Senior Infants

1st Class

2nd Class

3rd Class

4th Class

5th Class

6th Class

Teacher's Name *

Your answer

Declaration: I have no reason to believe that my child has infectious disease and I have followed all medical and public health guidance with respect to exclusion of my child from educational facilitities *

Yes

Submit

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