Clayville School Parent/Guardian Attestation
Please read carefully. This is information in regards to screening your child daily for COVID-19 prior to coming to school. Your signature at the bottom acknowledges you have read and understand this information.

*** A form must be completed for each child.***

This Attestation will be sent out DAILY for your signature. Our school nurse and secretary will collaborate to ensure each child has a completed Attestation form daily. The safety of our students, staff, and school community are our top priority.
Email *
Student First & Last Name *
School *
Grade Level *
Have you come in close contact (within six feet or at least 15 minutes) in the last 14 days with someone diagnosed with COVID-19, or has any health department or health care provider been in contact with you and advised you to quarantine? Scituate School Department is following the gold standard, our policy is that any person who tests positive for COVID-19 or is deemed a close contact by the Department of Health, must quarantine for 10 days before returning to school. *
Have you visited one of theses states within the last 14 days? * Scituate School Department is following the gold standard, our policy is that any person who travels to state on this list or out of the country must quarantine for 14 days upon return. *
Have your been out of the country within the last 14 days? *
Do you have any of these symptoms? Please check all that apply. *
*If you answered yes to any of these questions or checked off 1 or more symptoms, you will not be allowed in school. You should refrain from close contact with other individuals and you should contact your healthcare provider.
Your Signature
Your signature and date below acknowledge that you have read and understand the information above. By signing YOU WILL SCREEN YOUR CHILD EACH MORNING AT HOME and if any symptoms are present, the student will remain at home. Please contact your physician or school nurse with questions or concerns.
First & Last Name (this will note as your signature) *
Today's Date *
After-Illness Return Attestation
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