Very/High Risk Return Form

The following link may help discern what currently constitutes 'Very High Risk' and 'High Risk' in relation to COVID-19. Please take a moment to review the criterion prior to completing this form for your son/daughter.

https://www2.hse.ie/conditions/covid19/people-at-higher-risk/overview/

If, considering the criterion provided above, you still feel that your child(ren) falls into one of these categories, please complete this form prior to their return and a member of staff will contact you to discuss your situation.

Student Name *

First Name Last Name

Year Group *

1st Yr 2nd Yr 3rd Yr TY 5th Yr 6th Yr

Nature of your Concern *

Underlying Medical Condition Emotional/Anxiety Issues Learning Support Other

Please outline briefly details of your concern *

0/500

Please outline briefly any supports you feel might assist your child's return

0/500

Parent/Guardian Signature *

Clear

Parent/Guardian Email *

Confirmation Email example@example.com

Date *

Date