Notre Dame Parent and Student Health and Safety Expectations Form

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Please complete the Notre Dame Regional Secondary's Healthy and Safety Expectations Form, which outlines the responsibilities of the parent/guardian, as well as the student, to screen their child's health everyday before they come to school. Please complete the following form indicating that you understand what is expected of you, as a parent/guardian, when screening your child and expectations before they leave the house.

By submitting this form you are agreeing to complete the Health Screening each day with your child. Please complete this form by Wednesday, Sept 23rd.

Email *

Parent/Guardian's Last Name *

Parent/Guardian's First Name *

Student's Last Name (For multiple children at Notre Dame please fill out a separate form for each of your children) *

Student's First Name (For multiple children at Notre Dame please fill out a separate form for each of your children) *

What is your child's grade? *

Grade 8

Grade 9

Grade 10

Grade 11

Grade 12

Please check each boxes below acknowledging that you will assess your child(ren)'s health for each symptom listed before they depart for school. You will check that they do not have any of the following symptoms: *

fever/chills

sore throat, shortness of breath, cough or worsening of chronic cough

runny / stuffy nose

headache

fatigue

diarrhea, nausea, vomitting

loss of appetite, sense of smell or taste

muscle aches or abdominal pain

conjunctivitis (pink eye)

dizziness, confusion

skin rashes or discoloration of fingers or toes

Required

If my child answers "YES" to any of the questions, and the symptoms are not related to a pre-existing condition (eg. allergies), my son or daughter will not come to school. *

I understand that I need to keep my child home if any of the symptoms listed above are present and not related to any pre-existing condition my child may have.

Required

If my child shows any of these symptoms while at school, I understand that they will need to be picked up immediately. * *

I understand the importance of picking them up in a timely manner and that my child will be isolated in the sickroom while they wait for me.

Required

My child will have a mask with them to wear at school. *

I understand that it is the parent/guardian and student's responsibility to have a mask with them everyday at school.

Required

By submitting this form I am agreeing to all the items above, including performing a Health Check on my child everyday before they leave for school, and ensuring that they have a mask every day. *

Yes, I agree.

Required

A copy of your responses will be emailed to the address you provided.

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