Parental Declaration Form

Return to Education Facility

This form must be filled in and returned to the school when children are returning after any absence.

Child's Name(required)

Child's class 3rd class: Ms. J. O' Neill 3rd class: Ms. Mc Hugh 4th class: Ms. L. Carrick 4th class: Mr. D. Molan 5th class: Ms. D. Grant 5th class: Ms. A. Priest 5th class: Ms. Fitzpatrick 6th class: Mr. B. Watson 6th class: Mr. Kavanagh

Parent's / Guardian's Name(required)

Email(required)

Reason for absence:

Name of Setting:   

St. Bernadette’s Senior N.S.,   Quarryvale,   Clondalkin,    Dublin 22,   D22PW58

Principal’s Name:  Jim Ryan,  Principal

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please tick the box below

Declaration:

I declare that: – 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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Message (if you would like to provide more details)

Send declaration to school

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if you prefer you can use the “Text-A-Parent” link to complete the form on your phone

Complete and send declaration to school

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If you would prefer – you can download the form below, print it off and send it into the school.

return-to-work-formDownload

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