JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Level 2 - Health and Safety Survey
Does anyone in your bubble or extended bubble fall into the ‘vulnerable’ health category?
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Please write the name of your child/ren below.
*
Your answer
Does your child/ren have any developmental or behaviour issues that would prevent them from following the tight physical distancing rules that will be put in place for Level 2?
*
Yes
No
Required
Does anyone in your bubble or extended bubble have an underlying medical condition?
*
Yes
No
Required
Is anyone in your bubble or extended bubble immunocompromised?
*
Yes
No
Required
Does anyone in your bubble or extended bubble fall into one of the categories below or have another medical condition that puts them at risk?
*
Yes
No
Required
Do you intend on keeping your child/ren home for Level 2?
*
Yes
No
Required
Is there anything else you want us to know?
*
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Manaia School.
Report Abuse
Forms
