• Mallow (Miriam & Dawn) - Cloyne Diocesan Youth Services

    Covid - 19 Health Assessment
  • This Form MUST be completed by All Young People & their Parent/Guardian who are attending any group within CDYS. IF you are attending several Groups within the week you will need to complete this form for EACH group.  The form must be submitted 12-24 hour's before the group commences. 

     

    Failure to complete this form before attending will result in you not being able to gain access to any CDYS facility.

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    Pick a Date
  • If you have answered YES to any of the above questions you MUST self Isolate & Contact your GP.  You must NOT attend any CDYS Facility.

  • Should be Empty: