COVID-19 Travel Declaration Form for Parents

Schools can use this form to have parents declare their child's recent or upcoming travel and any household quarantine situations as part of campus health protocols.

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Child's Name

Nombre

Apellido

1. Has your child travelled abroad during the past 30 days?

Yes No

2. Does your child have plans to travel abroad during the rest of the year?

Yes No

3. Is your child living with a household member under Home Quarantine Order (HQO) or Stay-Home Notice (SHN)?

Yes No

Household Member's Name

Nombre

Apellido

Relationship

HQO/SHN Start Date

HQO/SHN End Date

4. What transportation you use to drop and pick up your child?

Private car School bus Public transport Walking Other

I declare that the information provided above is true and accurate

Date

Signature

Sign here

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