Anouska’s, The Grove – Coronavirus COVID-19 Information

All required fields are marked as *

Please provide parent/carer details responsible for your child, contactable in the event of an emergency:

Parent/Carer 1's Details

Parent/Carer 2's Details

In an emergency and we cannot speak immediately with either of the above parents/carers on the telephone, please provide two additional emergency contacts that we may call as responsible carers:

Additional Emergency Contact 1's Details

Additional Emergency Contact 2's Details

To be used at collection by additional emergency contact

Dietary Requirements *

Medical Requirements *

Sleep Information *

Please tick the relevant boxes below:

Toilet/Potty Training *

Declarations

You will be asked to sign below in person when you next attend after submitting this form, please now click Submit at the bottom of this page.

I understand the required procedure for drop-off and collection of my child from the setting during the Coronavirus pandemic

Signed .............................. Date .........................

I understand that if my child is showing any signs or symptoms of Coronavirus, they will be collected by a responsible carer as soon as possible and will self-isolate following government guidelines unless testing shows a negative result.

Signed .............................. Date .........................

I understand that if we or anyone in our household shows signs of Coronavirus, we shall notify the setting and self-isolate according to the government guidelines.

Signed .............................. Date .........................