Close Contact Attestation
Being unvaccinated, and under the guidance of Placer County Public Health, students who are identified as a CLOSE CONTACT (more than 15 minutes over a 24-hour period within 0-6ft with someone who tested positive for COVID-19) is eligible for a modified 10 day quarantine to ATTEND SCHOOL.

In the event that your child is identified as a CLOSE CONTACT and in order to limit disruption to your child's education, we are asking if your child is NOT vaccinated, that you complete this form to attest to have your child tested during any 10 day quarantine they may have. If your child tests positive at any time, you agree to share those results with the school and isolate immediately.

To be eligible for the modified quarantine, students must have been wearing a mask, and you must meet ALL of the following criteria:

1. Remain asymptomatic (if symptoms develop, stay home and isolate, notify the school, and get tested)
2. Continue to mask, as required
3. Undergo testing at least 2x during your 10 day quarantine. Testing is recommended 3-5 days post-exposure with the second test being taken on day 7.
4. Continue daily self-monitoring for symptoms through day 14 from last known exposure
5. Follow all recommended non-pharmaceutical interventions (i.e. wearing a mask when around others, hand washing, avoiding crowds)

This form only needs to be filled out ONE time PER FAMILY for the 2021-2022 school year for your unvaccinated children. If your child has already been a close contact this year, we are asking that you complete this new form.

Please note: if your child is NOT vaccinated for COVID-19, and you do not complete this attestation form, your child will have to quarantine at home if determined to be a close contact to a positive case at the school site.

This form will only be used by confidential personnel to determine quarantine. If you have any questions about the updated guidance, the form, or your particular situation, please contact Shanna Parker - Coordinator of Special Projects- COVID-19 Preparedness and Response at
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