The Carlow Academy

Declaration of Health Form Covid-19

In the interest of the Health and Safety of all our members at The Carlow Academy we would ask you to fill out this form in an honest and careful manner. If, after filling out this declaration, you or anyone in your family does develop Covid-19 symptoms or are deemed close contacts of a positive case of Covid-19 then please notify us immediately and keep your son/daughter at home by following public health guidelines.
Student's Full Name*

Please provide first name and surname. If you have more than one child attending The Carlow Academy then please fill out a separate form for each.
Parent/Guardian Name*

Please provide first name and surname
Parent/Guardian Mobile Contact Number*
Year Group (in school)*
Does anyone in your household have symptoms of cough, fever, high temperature (38 degrees C or above), difficulty breathing, loss or change in sense of smell or taste now or in the past 10 days?*
Has anyone in your household been diagnosed with a confirmed or suspected COVID-19 infection in the last 10 days?*
Is anyone in your household awaiting the results of a COVID-19 test?*
In the past 10 days, has anyone in your household been in contact with a person who is a confirmed or suspected case of COVID-19?*
Has anyone in your household been advised to self-isolate at this time?*
Has anyone in your household been advised to restrict your movements at this time?*
Please note that if you answered YES to any of the questions above then you will be required to self-isolate as per current public health guidelines. We are collecting this sensitive data for the purpose of maintaining safety within The Carlow Academy in light of the Covid-19 pandemic. Please remind your son/daughter to adhere to all health and safety guidelines outlined in The Carlow Academy and to keep a safe distance from other members at all times. Thanking you in advance for your full cooperation.
Please provide details below of any other circumstances relating to COVID-19, not included in the above, which may need to be considered to allow a safe return to The Carlow Academy for all e.g. returning from travel abroad AND/OR you can also list a set of weekly study times which will be saved on our attendance register
Admission Rules Consent*
I accept the Terms & Conditions.
Privacy Policy Consent*
I agree to the privacy policy.

Declaration of Health Form Covid-19

Want To Have A Consistent Routine? Then Become A Member Today

Want To Have A Consistent Routine?

Then Become A Member Today