Sahuarita Unified School District COVID-19 Parental Acknowledgment and Disclosure

Child's Name(Required)

First Last

Date of Birth(Required)

School(Required)

Each statement below should be read and acknowledged by either a parent or the child’s guardian. A signature by a parent or the child’s guardian is required.

Consent(Required)

I understand that it is my responsibility to inform other members of my household of the information contained herein and in the District’s Path Forward Plan.(Required)

Consent(Required)

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 and same household members may be separated from the rest of the class and moved to a supervised, secure area. I may be contacted, and my child and same household members MUST be picked up within 1 hour of being notified.

Symptoms include:

(Required)

Consent(Required)

I understand that, as the parent/guardian, I must conduct daily self-screening of my child for symptoms prior to the child arriving at school.(Required)

Consent(Required)

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

Consent(Required)

I will immediately notify the school health office 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.(Required)

Consent(Required)

The Site/District will continue to pursue the guidelines of the CDC, state and local health officials. As changes occur, parents and guardians will be notified. The Site Point of Contact will contact the Pima County Health Department if any staff member or student contracts COVID-19 to help make crucial decisions on the next steps.(Required)

Consent(Required)

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 choices I make for 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 and in the District’s Path Forward Plan.(Required)

Signature(Required)

I certify that I have read, understand, and agree to comply with the provisions listed herein.

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