COVID-19 SELF DECLARATION FORM

To be completed by pupil (or guardian if under 16)

I HEREBY DECLARE THAT THE PUPIL ATTENDING :

1. has not had a positive test for COVID-19 or been subjected to a mandatory quarantine period in the last 14 days;

2. not currently exhibiting any covid-19 symptoms such as a new continuous cough, raised temperature (37.8 or above) loss or change to sense of smell or taste,

3. has not been in close contacts with anyone who has tested positive for COVID-19 in the past 14 days;

4. will inform Fiona or Alison if any of the above statements change

5. Understands that this is a government requirement and that the Fiona Thomson School of dance will share your details with the NHS for track and Trace if asked to by officials

I (Pupil/Guardian) will contact the Fiona Thomson School of dance if I have any COVID-19 Symptoms or am asked to quarantine by the NHS Track and Trace Service.

Pupils Full Name (required)

Guardians Full Name if Pupil is under 16 (required)