COVID-19 Health Questionnaire

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7th Meath Dunshaughlin Scout Group

Scouting Year 2020 - 2021

Please fill in fully before each weekly scout meeting, failure to complete this by 4pm on the day of your child's scout meeting may result in your child not being able to attend their meeting

** I hereby declare that the information provided on this form is truthfully declared.

Email *

Child's Name *

Scout Section Attending *

Does your child have symptoms of cough, fever, high temperature, sore throat, runny nose, breathlessness, flu like symptoms or loss or change to your sense of smell or taste now or in the past 14 days? *

Yes

Has your child been diagnosed with confirmed or suspected COVID-19 infection in the last 14 days? *

Yes

Has your child or anyone in your family been in close contact with a person who is a confirmed or suspected case of COVID-19 in the past 14 days (i.e. less than 2 metres for more than 15 minutes altogether in 1 day)? *

Yes

Has your child or anyone in your family been advised by a doctor to self-isolate at this time? *

Yes

Signed by Parent / Guardian *

Date *

YYYY

Send me a copy of my responses.

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