COVID-19 Questionnaire/Self-Declaration

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.