COVID-19 Questionnaire/Self-Declaration

This form is to be completed prior to all workshops with Roscommon County Youth Theatre.

In the interests of the safety of all meeting participants, families and the community at large, Roscommon County Youth Theatre requests that you complete the following questionnaire/self-declaration. This form is to be completed by all meeting attendees, other than staff of Roscommon County Youth Theatre who have protocols in place for self-declaration.

Please submit the form below prior to all RCYT workshops & events.

1. Do you have symptoms of cough, fever, high temperature, sore throat, runny nose, breathlessness or flu like symptoms now or in the past 14 days? *
2. Have you been diagnosed with confirmed or suspected COVID-19 infection in the last 14 days? *
3. Is your son/daughter a close contact of a person who is a confirmed or suspected case of COVID-19 in the past 14 days (i.e., less than 2 metres for more than 15 minutes accumulative in 1 day)? *
4. Has your son/daughter been advised by a doctor to self-isolate at this time? *
5. Has your son/daughter been advised by a doctor to cocoon at this time? *
6. Has your son/daughter returned to the island of Ireland from another country with the last 14 days? *

Please click here if you are unsure whether or not you are in an 'at-risk' category.

I confirm that I have responded to the questions above truthfully based on my current condition.

I confirm, to the best of my knowledge, that my son / daughter has no symptoms of COVID-19, is not self-isolating or awaiting results of a COVID-19 test.

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