Menu
Home
About
About Karen
Links
Testimonials
Programmes
Speech & Drama
Secondary Schools
Primary Schools
Montessori
Adult
COVID-19
Calendar
News
Contact
Please enable JavaScript in your browser to complete this form.
Do you have symptoms of cough, fever, high temperature, sore throat, runny nose, breathlessness, loss of the sense of smell / taste or flu like symptoms now or in the past 14 days?
*
Yes
No
Have you been diagnosed with confirmed or suspected COVID-19 infection in the last 14 days?
*
Yes
No
Are you a close contact of a person who is a confirmed or suspected case of COVID-19 in the past 14 days (i.e. less than 2m for more than 15 minutes accumulative in 1 day)?
*
Yes
No
Have you been advised by a doctor to self-isolate at this time?
*
Yes
No
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 your safe return to Class.
Name
*
First
Last
Date
*
Email
*
I confirm that I have answered the above questions truthfully and to the best of my knowledge. I will inform Karen if at any-time in the future I answer yes to any of the above questions. Please enter your email, so we can follow up with you.
Name
*
First
Last
Comment
Submit