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HSE/HPSC Return to Educational Facility Parental Declaration Form
This form is to be used when children are returning to school after any absence.
https://www.hpsc.ie/a-z/respiratory/coronavirus/novelcoronavirus/guidance/childcareguidance/Return%20to%20Educational%20Facility%20declaration%20form.pdf
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* Indicates required question
Email
*
Your email
Child's Name:
Your answer
Class Teacher's Name:
Your answer
Parent/Guardian Name:
Your answer
Name of School:
Your answer
Date of Absence(s)
MM
/
DD
/
YYYY
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 facilities.
Agree
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Signed:
Your answer
Date:
MM
/
DD
/
YYYY
Submit
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