Safety Guide. As a valued member of our City Schools community, I commit to do my part to follow these protocols, so that we can help all our students and staff be well and thrive. In addition, I agree to: • Follow all rules for my child’s participation in school activities. • Collaborate with school staff to help ensure that my child follows all rules for masking, hand washing, and social distancing, as set forth in City Schools Health and Safety Guide and the Code of Student Conduct. • Ask my child the “Health Screening Questions” every day and keep my child at home if the answer to any of the screening questions is yes. (See page 3 for health screening questions that you should review each day.) • Keep my child home AND report to City Schools if my child has a confirmed or suspected case of COVID- 19. • If my child has a confirmed case of COVID-19 or is a close contact (within 6 feet for at least 15 minutes total over a 24-hour period) in the past 14 days with anyone diagnosed with COVID-19, my child cannot return to school until they complete any required quarantine or are cleared by an authorized health care provider. • Ensure that my child participates in City Schools COVID-19 Testing Program. (See page 2 for details.) • Ensure that, if my child becomes ill while attending in-person learning, my child is picked up promptly after receiving an on-site COVID-19 test. I understand that failure to sign and return this form will limit my child’s ability to fully participate in school programming. Furthermore, failure to comply with the rules herein may endanger our entire community and require City Schools to take steps necessary to protect the welfare of other students and staff in the building. For information on the risks associated with COVID-19, visit: xxx.xxxxxxxxxxxxxxxxxxxx.xxx/xxxxxx-xxxxxxxxxx. I acknowledge that I have reviewed these risks and expectations. Student Name: Grade: School Name: Parent/Guardian Signature: Date: Parent/Guardian Printed Name: Parent/ Guardian Phone Number: I understand that I may sign this form and return it to my school, or I may submit this form electronically by typing my name and date. I understand that electronic submission of this form constitutes and is the equivalent of my personal signature.
