COVID-19 Notification Form
This form is to be completed by parents if, for any reason, your child needs to isolate. Please provide as much detailed information as possible.
Once you receive your results please call the school office on 01606 288110 or email them on
office@wharton.cheshire.sch.uk
* Required
Email address
*
Your email
Child's Name(s)
*
Your answer
Child's Class(es)
*
Your answer
Parent Name
*
Your answer
Name of the person with symptoms
*
Your answer
Relationship of this person to your child(ren)
Your answer
Date of onset of symptoms
*
MM
/
DD
/
YYYY
Date of COVID-19 test
*
MM
/
DD
/
YYYY
What are the symptoms of the affected person?
*
Loss/Change of taste
Loss/Change of smell
Persistent cough
Raised temperature
Other:
Required
My child is currently:
*
Home Learning
Attending School
Any other relevant information
Your answer
Send me a copy of my responses.
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