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* 1. Parent's/ Guardian's Name

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* 2. Parent's/ Guardian's Email

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* 3. Parent's/ Guardian's Phone Number

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* 4. Students' Names and Grades ( please list all students who attend PCLC)

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* 5. When the COVID status is at Code Purple Level 4 (severely high exposure and spread of COVID-19 cases) for Hamilton County, my preference is:

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* 6. When the COVID status is at Code Red Level 3 (very high exposure and spread of COVID-19 cases) for Hamilton County, my preference is:

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* 7. When the COVID status is at Code Orange Level 2 (an increase in exposure and spread of COVID-19 cases) for Hamilton County, my preference is:

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* 8. I want my child(ren) to continue with remote instruction until a vaccine is available.

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* 9. I completely understand what is expected of me for my child to be successful during remote learning. This includes: checking teacher pages, making sure the computer is charged, ensuring my child is dressed for school, making sure my child eats breakfast before school, creating a quiet learning environment, making sure my child sign in to Zoom and attends ALL class sessions, checking the school calendar, and encouraging appropriate use of the computer.

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* 10. My child's teacher(s) regularly share(s) feedback on my child's work through (pick all that apply):

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* 11. During remote instruction, my child is being asked to do challenging work.

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* 12. The work my child is being asked to do is helping them learn new things.

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* 13. My child learns the most during remote instruction when their teacher(s): 

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* 14. When we are able to open the school building for in person instruction, will your child/ children need transportation to and from school?

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* 15. What is your greatest concern around your child reentering the school building for instruction this year? Please explain below.

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