miniMinds Health and Travel Declaration Form 2020
To ensure a safe and healthy environment for all students and staff, before sending your child to class, please take a few minutes to complete this required form and acknowledge the information is true to the best of your knowledge. 為確保學生及職員的健康及安全,在小朋友返學之前,煩請填寫以下表格,並確認所提供之回答真實無誤。

All students who have recently visited China or have any fever or flu-like symptoms must not take lessons for at least 14 days after returning to Hong Kong, and our team will arrange make-up accordingly. 如學生及其接送者最近曾經到中國或有發燒及感冒的病徵,在回港後至少14天內不能上課。本中心會安排補課。

If the form is not received before your child's class, we reserve the right to refrain students from attending classes. We greatly appreciate your understanding and cooperation during this time. 如本中心在小朋友上課前未收到此表格,本中心有權不批准學生上課。感謝你的體諒及合作。

Our centre is heightening our preventative measures to ensure a safe and healthy environment for all students and staff. 本中已加強防疫措施,以確保所有學生及職員有一個健康及安全的上課環境。

*Required fields 必須填寫
Email address *
Today's Date 今日日期 *
MM
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DD
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YYYY
Your child's full name in ENGLISH - FIRST name and LAST name e.g. Joyce LAM 學生姓名 (請用英文填寫 - 名字及姓氏) *
Your answer
Other siblings with the same health and travel history, you may include their names below too - FIRST name & Last name e.g. Joyce LAM 如有兄弟姊妹也是本中心之學生並有著相同的健康狀況及旅遊紀錄,也請把他們的名字在以下地方填寫:例如:Joyce Lam (名字及姓氏) *
Your answer
Mobile number 電話號碼 *
Your answer
Email address 電子郵件 *
Your answer
Course, Day & Class Time attending miniMinds? 就讀年級/班級/時段? (e.g. Learners 1 / Private Mon 3:00) *
Your answer
14 days before your child’s class date, has your child travelled to China and/or have come in to close contact with anyone who has travelled to China? 上課日期的前14天,學生及其接送者是否有到訪過中國內地或與到訪過中國內地的人有緊密接觸? *
14 days before your child's class date, has your child experienced any symptoms including fever or flu/cold-like symptoms such as cough, runny nose? 學生上課日期的前14天,學生及其接送者有沒有以下症狀 如發燒, 咳嗽, 流鼻水? *
Acknowledgement and Terms *
Thank you for your submission of this declaration form. Please kindly note that, for the safety of all children and staff, miniMinds has the right to refrain students from attending classes. To finish the form, please select the acknowledgement statement below and agree to the terms that this form was completed truthfully. Please see more detailed information in the link for prevention and control of disease: https://www.elegislation.gov.hk/hk/cap599D!en-zh-Hant-HK?INDEX_CS=N 多謝遞交健康申報表。請注意,為小朋友及所有職員之安全為理由,miniminds有權拒絕學生上課。本人已讀過及理解本申報表的所有問題。所提供之回答中本人所申報真實無誤。有關預防及控制疾病之詳細資料請參考以下連結:https://www.elegislation.gov.hk/hk/cap599D!en-zh-Hant-HK?INDEX_CS=N *
Required
Signature (e.g. John Smith) *
I hereby acknowledge by my indicated full name below as an electronic signature, that I have read, understand and agree to the terms of this declaration form to ensure the safety of all children and staff. 本人認可以下填寫之名字作為本人之電子簽名。本人已讀過及理解申報表的所有問題及協定,以確保小朋友及職員的健康及安全。
Your answer
A copy of your responses will be emailed to the address you provided.
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