Pembroke School Alert Level 2: Contact and tracing form

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Malo Lava Parents and Caregivers,
thank you for your supporting our processes to ensure the health and safety of our students and teachers. The successful completion of this form confirms your child's/children's attendance at school from Monday the 18th of May. It also confirms that your family will comply with the Pembroke School Health and Safety procedures. This form needs to be completed before your child/children enters our school bubble on Monday the 18th of May.

Ia Manuia

Junior Etuale Togia

Email *

Child/ren's names *

First contact in Alert Level 2 - Name and phone number *

Second contact in Alert Level 2 - Name and phone number *

Any additional information *

Name of adult/s dropping child/ren at school in Alert Level 2 *

Tracing details - Home address in Alert Level 2 *

Tracing details - Home Bubble. Please list the members in your home bubble. *

Tracing details for Guardian 1 - Please list your work/company name, address and work phone number. *

Tracing details for Guardian 2 - Please list your work/company name, address and work phone number. *

Please let us know if you have any questions or something you think the school should know about your child returning to school during Alert Level 2. *

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