Killeshin N.S. Return to School Questionnaire

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This questionnaire must be completed by parents or guardians prior to their child returning to school. One form must be completed for each child in your family.

What is your child's name? *

Please select your child's teacher: *

Does your child have any of the following symptoms: a cough, fever, high temperature, sore throat, loss of taste/smell, breathlessness or flu like symptoms now or in the past 14 days? *

Yes

Has your child been diagnosed with COVID-19 in the past 14 days? *

Yes

Have you been advised by the HSE that your child is a close contact of a person who is a confirmed or suspected case of COVID-19 in the past 14 days? *

Yes

It is a requirement for anyone coming into Ireland from another country to restrict their movements for 14 days. Restricting your movements means staying indoors in one location and avoiding contact with other people. Has your child returned from travel in another country in the last 14 days? *

Yes

I have no reason to believe that my son/daughter has an infectious disease. I have followed all medical and public health guidance with respect to exclusion of my son/daughter from educational facilities. *

Yes

Parent/Guardian Name: *

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