Critical Worker / Vulnerable Group Provision - 25 January 2021 - 29 January 2021

Please complete this form if your child will be attending school for on-site supervision during the week of 18 January 2021 - 22 January 2021.

For a definition of 'critical worker' and 'vulnerable children', please see the Government's guidance: https://www.gov.uk/government/publications/coronavirus-covid-19-maintaining-educational-provision/guidance-for-schools-colleges-and-local-authorities-on-maintaining-educational-provision

1. Name of Student

3. Does the student have an Education Health Care Plan?

Yes
No

4. Does the student have a Social Worker?

Yes
No

5. If you are a critical worker, which category applies to you?

(We may require proof of your eligibility as a critical worker)

Please provide details your job role

6. The new Government guidance has made it clear that "parents and carers should keep their children at home if they can". This applies to Critical Workers.

Please confirm that your child can not safety remain at home. *

I confirm that it is not safe for my child to remain at home and therefore I need a place reserved in the Critical Worker onsite provision

7. It is strongly recommended that your child is tested for Covid-19 on a weekly basis. To access a PCR test parents should use the government website (https://www.gov.uk/get-coronavirus-test) and answer the following:

Is the person who needs a test an essential worker?
No

Does the person who needs a test have coronavirus symptoms?
No, none of these symptoms

Has the person been asked to get a follow-up test?
No

Is the person who needs a test part of a trial or government pilot project?
No

Why are you asking for a test?
My local council or health protection team has asked me (or someone I live with) to get a test, even though I do not have symptoms

Please provide the date of your child's most recent PCR Covid-19 test.

	DD/MM/YYYY

8. Please indicate the result of the latest PCR test

Negative
Positive

9. Name of Parent

10. Parent Email

11. Parent Contact Number (in case of emergency)

12. Second Emergency Contact Name

13. Second Emergency Contact Number

14. Which days will your child be attending this week?

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