Parental Agreement/Attestation

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Parent/Guardian Agreement/AttestationDaily Home Health Screening for School Attendance
The Derry Cooperative School District places the greatest value on the health and safety of our students and staff. In the face of the current global COVID-19 pandemic and in order for school to remain open to in-person learning, it will take the cooperation of everyone in the school community to implement the district's safety measures in accordance with the requirements of the back to school guidance from the New Hampshire Department of Education.
Per NH DHHS Guidance and Recommendations, parents/guardians are asked to work with the school district by taking an active role in the required daily assessment of their child(ren), before they arrive at school. Parents/guardians need to assess/screen their children for symptoms of contagious illness or risk factors daily before allowing them to travel to school. This daily screener/symptom checklist provides guidance to help clearly identify what symptoms and risk factors warrant the student to stay at home. Please note that if a child has any signs of illness, even if they are mild, they must be kept home, to protect the school and community at large.
We are requiring this agreement to be signed by each student’s parent/guardian before the first day of school. Frequent reminders will be sent regarding the health guidelines for school attendance. Please note the screening guidelines may change throughout the year, based on the recommendations from the NH Department of Health and Human Services. You will receive updates from the school district regarding any significant changes. The following websites are also available for up to date information.
Educational Institution COVID-19 FAQ
Guidelines for student school attendance:
1. Any student showing symptoms of COVID-19 should not be at school. A wide range of symptoms have been reported, ranging from mild symptoms to severe illness. Symptoms may appear 2-14 days after exposure to the virus. Students with any of these new and unexplained symptoms (that are not related to a chronic condition that is medically documented in the student’s school health record) even if mild, may have COVID-19:
● Fever/chills - Fever is considered 100.0 degrees or higher
● Cough, shortness of breath or difficulty breathing
● Fatigue, muscle or body aches
● Headache
● New loss of taste or smell
● Sore throat
● Runny nose or nasal congestion
● Nausea or vomiting, diarrhea
2. Any student who has had a close contact exposure (within 6 feet for at least 10 minutes) in the last 14 days with someone suspected to have or has been diagnosed with COVID-19 should not attend school.
3. Any student who has traveled in the prior 14 days outside of New Hampshire, Vermont, Maine, Massachusetts, Connecticut, or Rhode Island should not be at school.
If a student falls into any of the above circumstances, preventing them from attending school, the parent should contact the school nurse or administration for guidance on return to school. Please note: If students test positive for COVID-19, or have had symptoms and were not tested, they are unable to return to school until they have met the NH DHHS and the CDC’s criteria for return. These include: (1) At least 24 hours after resolution of fever (≥ 100.0) without the use of fever reducing medicines. (2) Symptoms have improved. (3) It has been at least ten days since symptoms first appeared.
I have read and understand these health guidelines. I attest that I will do a daily screening/assessment of my own child for symptoms and/or known exposures to COVID-19.  I will keep my child at home if they do not meet the school attendance health criteria as listed and will contact my child’s physician or school nurse as needed.
 Please complete a separate form for each child in your family attending school on-site.

Student Name ( 1 child per form) *
Student School *
Grade Level *
Contact number *
Parent/Guardian Name *
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