Health Declaration - 11 Plus Tuition

COVID-19 HEALTH DECLARATION

Parent/Guardian's Full Name: *

Child's Full Name: *

Email Address *

Have you/your child been out of the UK in the last 30 days? *

If so, please list the areas you visited along with the dates of travel: *

Have you/your child been in contact with anyone who has been infected, suspected or diagnosed with COVID-19? *

If so, please list your relationship to each person and the date that you last had contact with them? *

Have you/your child experienced, or are currently experiencing a COUGH in the last 14 days ? *

Have you/your child experienced, or are currently experiencing a FEVER in the last 14 days ? *

Have you/your child experienced, or are currently experiencing SHORTNESS OF BREATH in the last 14 days? *

Have you/your child experienced, or are currently experiencing PERSISTENT PAIN IN THE CHEST in the last 14 days ? *

By submitting this form you confirm that the information given is accurate and complete. You also agree to contact edgbaston@elevenplus.co to inform us immediately if any of the answers given change. Furthermore you confirm that you have read, understand and agree to abide by the guidance provided on the 11 Plus Social Distancing Measures page at: https://elevenplus.co/social-distancing/ *

Please tick this box to confirm that the information you have given is correct.

COVID-19 HEALTH DECLARATION

Login

Register