On-Site Attendance / COVID-19 Declaration Form

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The Victorian Government has stated that all students who can learn from home must learn from home.

Parents/carers who require their child/ren to attend on-site learning at school will need to complete this form by 3.00 p.m. on the Thursday of the week prior to their children attending on-site.

This process needs to be completed weekly to ensure adequate staffing on-site.

This provision will be for supervision only. Students attending on-site will be learning remotely, just like every other student. They will not have their regular classroom teachers, but will be supervised by a number of staff on a rotating roster.

To ensure the ongoing health and well-being of all members of our school community, St. Patrick's School requires all Parents/Carers to complete this Declaration Form on behalf of their child/ren upon returning to school.

All information provided will be dealt with in the strictest of confidence in accordance with the Australian Privacy Principles contained in the Commonwealth Privacy Act 1988 as detailed in the school’s Privacy Policy. A copy of the Privacy Policy is available on the school’s website.

St. Patrick's School reserves the right to refuse your child/ren and yourself entry to the school if you have answered Yes to any of these questions. We trust that you appreciate your declaration is in the best interests of the health & well-being of all members of our school community.

Your Name *

Your Child/ren's Name/s *

Has anyone who lives at your address returned from domestic or international travel within the last 14 days? *

Yes

In the last 14 days, has anyone who lives at your address been in physical contact with a person/s who has been diagnosed with the COVID-19 virus? *

Yes

Is anyone who lives at your address currently under a form of self-isolation as a result of an order of a government authority or as the result of a recommendation by a health professional? *

Yes

In the last 14 days, has anyone who lives at your address been in physical contact with a person/s who is in self-isolation due to the COVID-19 virus? *

Yes

In the last 14 days, has anyone who lives at your address experienced symptoms such as: >Flu-like symptoms >Fever >Coughing >Shortness of breath >Fatigue *

Yes

Dates required (week of 1 June)

All Day

Monday, 1 June

Tuesday, 2 June

Wednesday, 3 June

Thursday, 4 June

Friday, 5 June

Disclaimer *

I am requesting that my child/ren attend on-site schooling because my child/ren is/are not able to be supervised at home and no other arrangements can be made.

I declare that the information provide is a true and proper representation of our family's health and recent community interaction. I commit to informing St. Patrick's School if these circumstances change.

By submitting this form, I declare that my child/ren is/are well and I will collect my child/ren as soon as is practicable upon the request of the school if my child becomes unwell.

Required

Signature (by entering your name or initials) *

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