Return to Class/Work

Centre Stage School 'Return to Class/Work' Declaration

We have been guided by the HSA 'Return to Work' form in preparing these questions. To help prevent the spread of COVID-19 in our studios, every student (Parent for those under 18yrs of age) must complete this form before returning to Centre Stage School. Every question must be answered below before returning to class. We appreciate your understanding in this matter, so thank you!

Student Name*
Parent Name (for those under 18)*
Email address*
Date*
DD
/
MM
/
YYYY
Do you have symptoms of cough, fever, high temperature, sore throat, runny nose, breathlessness, flu like symptoms or loss or change to your sense of smell or taste now or in the past 14 days?*
Have you been diagnosed with confirmed or suspected COVID-19 infection in the last 14 days?*
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 2 metres for more than 15 minutes altogether in 1 day)?*
Have you been advised by a doctor to self-isolate at this time?*
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 work.
Do you take upon yourself to be responsible for limiting the spread of infection while engaging in Centre Stage activities which will include good hand and respiratory hygiene plus changing your clothes into your CSS uniform if coming from school or another group activity?*
Have you traveled to any country outside of the Republic of Ireland in the last 14 day? Please provide details below if you answered yes. *
Details of where and when you travelled outside of the Republic of Ireland in the last 14 days (if any)
Should your situation change after you complete and submit this form please inform Centre Stage School at your earliest convenience

Return to Class/Work

Centre Stage School 'Return to Class/Work' Declaration

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