Return to Kildare Youth Theatre Questionnaire COVID-19
This questionnaire must be completed by members at least 5 hours in advance of returning to workshop, rehearsal or any other Kildare Youth Theatre / Crooked House activity. If the answer is Yes to any of the below questions, you are advised to seek medical advice before returning.

Name of member *
Name of parent/guardian *
Please select your workshop/rehearsal *
Do you have symptoms of cough, fever, high temperature, sore throat, runny nose, breathlessness or flu-like symptoms 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 2m for more than 15 minutes accumulative in 1 day) *
Have you been advised by a doctor to self-isolate at this time? *
Have you been advised by a doctor to cocoon at this time? *
Have you been advised by your doctor that you are in an at-risk group? If yes, please liaise with your doctor and parent/guardian regarding returning to KYT or Crooked House. *
By completing this form I confirm, to the best of my knowledge that I have no symptoms of COVID-19, am not self-isolating or awaiting results of a COVID-19 test. Please note: The organisation is collecting this sensitive personal data for the purposes of maintaining safety within the workplace in light of the Covid-19 pandemic. The legal basis for collecting this data is based on vital public health interests and maintaining occupational health and will be held securely in line with our retention policy. This form needs to be submitted once. If any of the symptoms develop afterwards you need to stay at home and send us a text message: 087 2759420. We will then facilitate remote participation by video call if possible or required.
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