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St.

Michael’s Scoil Mhichil,


Rackwallace Rath Mhic Mhalais
Monaghan Muineachán
H18 XY66 H18XY66

secretary@stmichaelsns.com 047-85282

COVID-19 Return to Educational Facility Parental


Declaration Form

Child’s Name: Principal’s Name: Séamus Grundy


Parents/Guardian’s Name:
Name of Setting: St. Michael’s N.S. Rackwallace

This form may be used when children are returning to the setting after any absence.

Declaration:
I have no reason to believe that my child has an infectious disease and that I have
followed all medical and public health guidance with respect to the exclusion of my
child from educational facilities.

Signed

Date:

Roll number: 16954C Charity Number: 20132170 twitter: @rackwallacens website: www.rackwallacens.com
Roll number: 16954C Charity Number: 20132170 twitter: @rackwallacens website: www.rackwallacens.com

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