Chronic symptoms Parental Declaration Form

* Indicates required field

Child's Name *

First

Last

Parent/ Guardian's Name *

First

Last

Child's Teachers Name *

First

Last

Name of Setting:
Galway Educate Together National School

This form is to be used when children experience chronic symptoms which might cause concern in light of COVID-19.

Declaration:
My child has specific symptoms linked to a condition (s)he receives medical advice for e.g. chronic cough in a child with asthma.

Symptoms child experiences: *

These symptoms are consistent with his/her stable condition and are not related to COVID-19. I understand that if my child becomes unwell, or the symptoms change, they will be excluded and will be discussed with their GP, as per national recommendations.

Signature *

Date *

Email *

Any other comments *

Submit

​Chronic symptoms Parental Declaration Form

Chronic symptoms Parental Declaration Form