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Coronavirus Emergency Childcare for Weekends Form

Please note


Step 1 of 3

Child and Parent Details

Step 2 of 3

Weekend: Saturday Sunday
Drop off time:
Collection time:

Step 3 of 3


Child or children’s name(s) :

Child's Date of Birth :

Does your child need medication and\or have any food allergies? If so please specify :

School name(s) :

Preferred Provision :

Parent 1 Key Worker (name) :

Parent 1 Occupation as key worker criteria :

Parent 1 - What critical tasks do you undertake that make your work vital at this time? (If emergency services or medical please just state your place of work) :

Parent 1 Emergency Contact number :

Parent 2 Key Worker (name) :

Parent 2 Occupation as key worker criteria :

Parent 2 - What critical tasks do you undertake that make your work vital at this time? (If emergency services or medical please just state your place of work) :

Parent 2 Emergency Contact number :

Emergency Contact Name :

Emergency Contact Number :

Weekend: Saturday Sunday
Drop off time:
Collection time:

Please indicate the weekends over the next 6 weeks when childcare would be required :

Please write any additional information the parent/carer would like to communicate to staff (this is to minimise the time of face to face contact): :

As parents/carers we understand that:-

The emergency childcare facility may be withdrawn or changed at anytime depending on government direction.

The school will not function as a school but has been repurposed for emergency childcare cover and that my child will not be taught, have lessons or follow a school timetable.

My child may not be cared for in their own classroom or by their own teacher or by the same person all the time. My child may be with children of all primary school ages depending on how the facility will be organised. My child does not need to wear uniform and I will provide an additional set of clothes in a bag. A packed lunch must be provided on Saturday and Sunday.

Whenever possible my child will be kept  at a distance of 2 metres away from all others.

We/I will stand 2 metres away from staff other members of the public whenever possible during drop off and collection.

We/I must provide proof that BOTH parents reach the critical key worker criteria.

We/I must provide proof of BOTH parents work schedules on a weekly basis to take into account different shift patterns.

School will refuse admission of my child if the strict criteria is not adhered to.

We/I will endeavour to minimise the time my child spends at the facility to reduce the risk of infection and safeguard themselves and others. (this may mean picking up and dropping off at different times and days  - complete a time schedule

Any person being verbally abusive will be asked to leave the premises.   

We/I understand the facility is open between 8am and 6pm on weekends

We/I as a parent have made every effort to find home based child care and have absolutely no alternative.

We/I understand that keeping my child at home is the best option for the prevention of becoming infected.

We/I understand that there is a risk that my child could become infected within the school building.

In the event that a member of the household is displaying symptoms of the Coronavirus, I must telephone the school to inform them. All members of my household will self-isolate for 14 days after symptoms appear. We will continue to restart the 14 day rule should other members within the household become infected.

No person displaying the symptoms should come onto school premises even if it is to drop off.

If staff become ill they will self-isolate for 14 days.

If numbers of staff reduce because of illness the facility will close

The school building could be repurposed for an alternative facility in the future depending on government direction.

These are unprecedented circumstances that are changing daily, information will be shared as quickly as possible. We, as parents, will be as understanding and cooperative as possible in order to safeguard our family’s communities and to essentially save lives.


Form submitted

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