Dear parents,

To raise the awareness in student’s physical conditions under the COVID-19, we have provided the departure and physical record sheet as follow. Please fill in the record sheet and hand it in to the class teacher when the class resume. 

Yours sincerely, 

Lok King Kindergarten

Principal Luk Kwan Yin

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【The departure and physical record sheet】

Student’s name:_________________________         Class: ____________

1. The departure record of the student during holidays My child   * departure  /  did not departure  Hong Kong for travelling / visiting relatives Departure period: from ____________ to ____________Place: (Please state)                                
2. The physical condition of student during holiday  My child  * suffered  /  did not suffer  from the influenza / pneumonia / COVID-19 and has recovered already. He / She has stayed at the hospital from____________ to ____________. 
3. Close contacts with the patients during holidays My child  * has  /  does not have  close contacts with the patient who is suspected or confirmed cases of  * influenza  /  pneumonia  /  COVID-19 . And that patient is  * recovered  /  still receiving the hospital treatment. 

Reminders:  -  Personal Information Collecting Statement- All the information provided are for setting up the infection control guidelines of school only. Information that stated in the record sheet will be disposed at the end of this school year. 

• The students have close contact with the patients of influenza / pneumonia / COVID-19. Close contact means any person having cared for, having lived with or having had direct contact with respiratory secretions and body fluid of a person. 

Parent’s signature：__________________          Date： _________________

* Please delete as appropriate