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APRIL 26th 2021 WHS STUDENT ATTESTATION FORM
BEFORE sending your child to school for their in person learning days next week, please review the following questions and select either “YES” or “NO.”
 
If you answer YES to any of these questions, YOU MUST contact WHS directly at 508 836 7720. DO NOT send your child to school in that case.

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What is your child's first name? (Please do not leave a space after the name) *
What is your child's last name? (Please do not leave a space after the name) *
OPTIONAL, but helpful: What is your child's ID number (this is also their 4 or 5 digit lunch code)?
1. Is your child or is anyone in your family/close contacts currently diagnosed with COVID-19? *
2. In the past 10 days has your child experienced any symptoms of COVID-19: Fever (temp >/= 100.0) or chills, cough (not due to other known cause such as chronic cough), shortness of breath or difficulty breathing, new loss of taste or smell, sore throat, headache (when in combination with other symptoms), muscle or body aches, GI Symptoms: Nausea, vomiting, diarrhea, fatigue (when in combination with other symptoms), congestion or runny nose, (not due to other known causes such as allergies) when in combination with other symptoms? *
3. In the past 14 days has anyone in your family/close contacts experienced any symptoms of  COVID-19? *
4. In the past 10 days has your child travelled outside of Massachusetts? *
If you answered YES to question 4, has your child been tested according to the state guideline? (See: Quarantine and Testing Requirements at https://www.mass.gov/info-details/covid-19-travel-order#quarantine-requirement-and-testing-options-) Please notify your school nurse and supervisor of your testing status.
By completing this form, I certify that my child's daily attendance at school is an attestation that he/she continues to meet all of the above criteria. If the answer to any of the above questions changes in the future, I will notify my child's school immediately and I will NOT send my child to school until I speak with the school and confirm that my child may attend.   TYPING YOUR NAME HERE SERVES AS YOUR SIGNATURE *
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