Weekly Declaration Form

Parent Full name

Child's name

Parent EID Number

Class

Age

In response to the recent Coronavirus (COVID -19) ABC Nursery is taking precautions to lessen the spread of the virus. All parents must read and sign the declaration form on weekly and send to the nursery electronically

I have not, or any of my family members in my household, been in contact with someone who is suspected of being infected with COVID-19 or someone diagnosed with COVID-19.

If yes please mention the date:

Date

As identified by the authorities in the UAE, I have not recently experienced/ experiencing any of the following symptoms of COVID-19:

Fever
Cough with shortness of breath
Repeated shaking with chills
Muscle pain
Headache
Sore throat
Loss of sense of taste and/ or smell

I recognize that the following chronic diseases are considered as high risk and could pose complications with COVID-19. I acknowledge that if I have or anyone in my family has the following chronic illnesses, and that if I choose to send my child to the nursery, I am exposing myself or my family members with the chronic disease to an added risk if exposed to COVID-19. The following illnesses include but may not be limited to:

Cancer
HIV
Recent transplants
Respiratory issues
Kidney or heart issues
Inflammation

I hereby acknowledge and undersign that the information I have provided above is accurate and correct. I’m fully aware of the risks/threats posed to the community if I fail to adhere to the Nursery Guidelines, and shall immediately notify the nursery in the event of myself or my child being infected by Covid-19, or if I suspect that my child or I have been infected or exposed; or if I/my child show any symptoms of being infected by the said virus and that ALHOSN application has been downloaded and is active.

This is a declaration from me, the undersigned, that I shall comply with all the above and with all procedures issued by relevant authorities

Name

Date

Thanks for submitting!