Isolation Return Form

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In planning for your child's return from isolation, please complete the form below.

Child' Last Name *

Child's First Name *

Student Identification Number *

Child's Grade Level *

What is your child's earliest approved date of return? *

YYYY

Per recent CDC guidance, students may return to school after 5 days of isolation provided their symptoms have been resolved and they wear a mask. Realizing these students are also required to distance six feet when not wearing a mask, adjustments will need to be made for your child during breakfast/lunch. Please select one of the options below: *

I give permission for my child to eat in an alternate breakfast/lunch location for the remainder of the 10-day period and to wear a mask at all other times while in school.

I do not give permission for my child to eat in an alternate breakfast/lunch location or to wear a mask at all other times while in school. I will instead opt to keep my child home the entire 10 days.

Who is your child's lunch teacher (if known)? *

Electronic Signature - Your name below verifies the conditions for your child's return as it pertains to masking and breakfast/lunch. *

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