COVID-19 Parental Ackowledgement and Disclosure

Dear Parent or Guardian,

Dear Parent or Guardian:

Below please find a form entitled, COVID-19 Parental Acknowledgement and Disclosure. It is important that you read it carefully, sign it, and electronically submit it to us before the start of in-person learning on October 13.

At a time when so much misinformation is circulating, we want you to clearly understand your responsibilities—and our objectives—when it comes to the safety of your child and our teachers, administrators, and staff.

While the form may seem long and detailed, the messages are those you’ve heard before:
• You must take your child’s temperature every day before school. (A temperature of 100.4 degrees Fahrenheit or higher is considered a fever.)
• If your child is sick, they must stay home.
• For safety reasons, parents and guardians will not be allowed on campus
past the drop-off area unless there is an emergency.
• If your child comes into contact with someone who may have COVID-19, or
who tests positive for COVID-19, you must let us know.
The form also confirms the school’s and district’s intent to:
• Monitor students for symptoms that could indicate a coronavirus infection, and if they do show symptoms, to call you right away to pick them up and take them home.
• Remain aware of changes in Centers for Disease Control (CDC) guidelines, and to follow the guidance of the CDC, the Pinal County Health Department, and the Arizona Department of Health Services.

Each statement below should be read and answered by either a parent or the child's guardian. Electronic signature is required.

A new form for each child in the household is REQUIRED. Do not add multiple children to the form.

Question Title

* 1. Student Name( Last, First)

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* 2. Student Date of Birth

Date/Month/Year

Date

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* 3. I understand that during this COVID-19 public health emergency, I will NOT be permission to enter the school beyond the designated drop-off and pick-up area. I understand that this procedure change is for the safety of all persons present at the school and to limit to the extent possible everyone's risk of exposure.

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* 4. I understand that it is my responsibility to inform other members of my household of the information contained herein.

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* 5. I understand that IF there is an emergency requiring me to enter the facility beyond the designated drop-off and pick-up area, I MUST wash my hands and wear a mask before entering. While in the facility, I will practice social distancing and remain 6 feet from all other people, except for my own child.

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* 6. I understand that in order to attend school, my child must be free from COVID-19 symptoms. If, during the day, any of the following symptoms appear, my child will be separated from the rest of the class and moved to a supervised, secure area. I will be contacted, and my child MUST be picked up within 1 hour of being notified. Symptoms include: fever of 100.4 degrees or higher, chills, shortness of breath or difficulty breathing, fatigue, muscle or body aches, headache, loss of taste or smell, sore throat, congestion or runny nose, nausea or vomiting, diarrhea, or any other symptom of illness, whether or not you believe it is related to COVID-19. Students will need to be symptom free for 24 hours before returning to school.

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* 7. I understand that as the parent/guardian, I will need to take my child’s temperature prior to coming to school. I understand that, as the parent/guardian, I must also conduct daily self-screening of my child for symptoms prior to the child arriving at school

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* 8. I understand that over the course of the school day, my child’s temperature may be taken.

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* 9. I understand that my child will be required to wash their hands throughout the day using CDC-recommended handwashing procedures.

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* 10. I understand that my child must wear a face covering throughout the day according to the protocols established by the District.

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* 11. I will immediately notify the Superintendent if I become aware that my child has had close contact with any individual who has been diagnosed with COVID-19. The CDC defines “close contact” as being within 6 feet of an infected person for at least 15 minutes starting from two days before illness onset (or, for asymptomatic patients, two days prior to specimen collection) until the time the patient is isolated.

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* 12. I understand that CAVIT will continue to follow the guidelines of both the CDC and state and local officials. As changes occur, parents and guardians will be notified. The Superintendent will contact the Arizona Department of Health Services if any staff member or student contracts COVID-19 to help make crucial decisions on next steps.

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* 13. I understand that, while present at school each day, my child will be in contact with children and employees who are also at risk of community exposure. I understand that no list of restrictions, guidelines, or practices will remove the risk of exposure to COVID-19. I understand that the members of my family play a crucial role in keeping everyone at school safe and reducing the risk of exposure by following the practices outlined herein.

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* 14. I, _______________________________________________, certify that I have read, understand, and agree to comply with the provisions listed herein. (Type your full name in the space provided. This will serve as a signature.)