HSE/HPSC Return to Educational Facility Parental Declaration Form - Room 20
Email address *
Child's Name *
Class Teacher's Name: *
Parent/Guardian Name: *
Name of School: *
Date of Absence(s) *
MM
/
DD
/
YYYY
Reason for absence *
Declaration: I have no reason to believe that my child has infectious disease and I have followed all medical and public health guidance with respect to exclusion of my child from educational facilities. *
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