Liscard Covid-19 (Coronavirus) Parent/Carer Agreement
This agreement must be completed by a parent/carer for children attending Liscard Pirates Club & EYFS WrapAround Provision; your child(ren) will not be able to attend our provision without an agreement in place prior to this.

I acknowledge the contagious nature of Coronavirus and that the latest government guidance recommends practising social distancing and a range of other protective measures.

I recognise that Liscard Pirates Club & EYFS WrapAround Provision has put in place a series of protective measures to reduce the risk of Coronavirus transmission within the setting, but I accept that Liscard Pirates Club & EYFS WrapAround Provision cannot guarantee that my child will not be exposed to Coronavirus whilst attending the club.

I understand that I must follow the procedures set out by the organisation when dropping off and collecting my child from the setting.

I understand the importance of vigilance regarding Coronavirus symptoms as a keystone of preventing the transmission of the virus to other children, staff and parents/carers.

Accordingly, I confirm that:
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Email *
My child is not experiencing any Coronavirus symptoms such as cough, shortness of breath or difficulty breathing, fever, muscle pain, headache, sore throat, or new loss of taste or smell. *
My child has not tested positive for Coronavirus, or been advised by NHS Test & Trace to self-isolate. *
My child has not been in contact with anyone in our household who has Coronavirus symptoms, or who has been advised by NHS Test & Trace to self-isolate. *
My child has not travelled abroad to any country other than those identified as ‘safe’ by the government within the last 14 days. *
My child is capable of following the club rules relating to protective measures, such as not mixing with children in other bubbles, washing their hands regularly, coughing and sneezing into a tissue and disposing of it safely, and not touching other children. I understand that if they are unwilling to follow the rules they may not be allowed to attend future sessions. *
If any of the above circumstances change, I will not bring my child in to the club and will notify the club staff immediately. *
Parent/carer name *
Full name of child(ren) *
Date *
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A copy of your responses will be emailed to the address you provided.
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