Covid-19 Agreement Form

  • Covid-19 Return to Childcare Questionaire


  • Please Tick your answers below :

  • Is your Child suffering from any of the below Flu or, Covid-19 sysmptoms?


    Most common symptoms:

  • Less common symptoms​:

  • Serious Symptoms:

  • Note: When on Site, children will adhere to the on-site standard processes / procedures regarding infection control, i.e. hand washing / hand sanitizing and general coughing / sneezing etiquette.

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  • Please Note that this agreement is in addition to any existing Parent / Guardian agreement.

  • That I will complete the “Return to Service Form” for my child

    The services new arrival and collection procedures which are outside in our Covid-19 Policy and Procedure (Please Request from School)

    That I will maintain social distancing of 2 meters from other adults and children while at the service and I will not enter the building. Settling – In should be discussed with the Manager

    That I will NOT bring my child into the service if they are unwell

    That I will check my child’s temperature each morning before coming into the service and, if it is elevated, I will keep my child at home and contact my GP

    That my child and I will wash our hands before leaving home and on arrival at the service (use hand gel dispenser if no running water near the entrance)

    That my child will wear freshly washed clothes each day

    That my child will NOT bring toys or any other items into the service from home. If a child has a favourite comfort, it can be left in the service for use by the child

    That I will not leave Buggies or any other equipment at the service

    The procedures if my child becomes unwell while at the service which are outlined in the Covid-19 Policy (Please Request from School)

    That I will collect my child immediately if my child becomes unwell while at the service

    To ensure the emergency contact number is on file and can be contacted

    That if my child is ill or quarantines normal fees apply

    Your signature below indicates your agreement with the above statements and confirms you have received a copy of the Covid-19 Policy and Response Plan.

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