COVID Declaration form | AgapeMontessoriHouse

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Agape Montessori House

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Agape Montessori House Kindergarten

COVID-19 Declaration form

Parent's name

Parent's NRIC

Child's name

If your child has any of the following symptoms, please tick the corresponding box.

Symptoms

Fever

Cough

Sore Throat

Shortness of breath

Loss of sense of smell or taste

Is unwell in any other way

Person residing in the household has any of the above symptoms

Date

Time

I declare the above to be true to the best of my knowledge

(+65) 9789 9829

agape_montessori@yahoo.com.sg

© 2019 by Agape Montessori House Kindergarten

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