Covid-19 Self Declaration Form _ Existing Students

Covid-19 Self-Declaration Form_ Students in Ireland

Covid-19 Self-Declaration Form_ Students in Ireland

To help prevent the spread of COVID-19 in the school, every student must complete and sign a COVID-19 Self-Declaration Form before returning to face-to-face classes at school. On review of the form, management may contact you to ask you not to start school immediately, and in this case, will discuss a suitable alternative date for your start.

Please note that you must continue all government guidance and restrictions relating to Covid-19. You must restrict your movements if you have been in close contact with a confirmed, positive COVID-19 case or if you live with someone who has symptoms of COVID-19.

Do you have symptoms of Covid-19 now or have you had symptoms in the past 14 days? (Symptoms of Covid-19 are: cough, fever, high temperature, sore throat, runny nose, breathlessness or flu like symptoms) *
Have you been diagnosed with a confirmed or suspected COVID-19 infection in the last 14 days? *
Are you a close contact of a person who is a confirmed case of COVID-19 in the past 14 days? *
Have you been advised by a doctor to self-isolate at this time? *


(Please Read Carefully)
I am familiarised with current restrictions in place in Ireland. I agree to follow all government restrictions while in Ireland *
I have read and understood Atlantic Language School's Safety Protocols. *
I will wear a facemask and maintain social distancing at school at all times *
I agree to follow all Atlantic Language school Covid-19 prevention protocols at all times *

Confirmation and Data Protection

I confirm that the above information is correct. I agree that my data may be used to contact me to verify the provided information and that it may be used for the purposes of contact tracing in relation to confirmed or suspected cases of Covid-19.

I consent to the use of my details for the purpose of processing this form.
Please tick this box to confirm you have completed this form accurately.

If any of your answers above ever change, please let us know in advance of attending the school.