Student Health Attestation- March
Daily health screens are mandatory in order for in-person school to occur and to keep occurring. Parents will be expected to screen their students before arriving at school, and must complete the attestation form below. Please review the following health-related questions for your student. If your child has ANY symptoms listed below, do not send the student to school or board the bus, and contact the school to let them know of their absence. If your student exhibits any of these symptoms at school, they will be sent home, and will need to be picked up immediately. Please make sure the school has up-to-date, LOCAL emergency contacts for your student, and that you have an emergency backup plan in place during times when you are not close to your child’s school. This form will be completed monthly for elementary students and will be kept on file. If you have any further questions, please take the time to review the district infectious disease policy 3414 and procedure 3414P or reach out directly to the nurse at your student's school. *
Sign in to Google to save your progress. Learn more
Email *
Which school does your student attend? *
Students First Name *
Students Last Name* *
Student's Grade *
I agree that if my student has ANY of the following symptoms that are not attributed to another condition, I must agree to keep them home, call them in sick to the school and keep them out of school in accordance with timelines set forth by the health district and/or the school nurse.                                                                       - A temperature of 100.4 or greater (before any fever-reducing medication)                                                            -Cough, shortness of breath or difficulty breathing      - Sore throat, nasal congestion or runny nose                  - Recent loss of taste or smell.                                              - Muscle or body aches                                                           - Nausea, vomiting or diarrhea                                              - Unusual fatigue *
I agree that if ANY of the following conditions apply to my student, I must agree to keep them home, call them in sick to the school and keep them out of school in accordance with timelines set forth by the health district and/or the school nurse.        - Been in contact with anyone suspected of having COVID-19           -Have had a positive COVID-19 test for active virus in the past ten days -Are awaiting the results of a COVID-19 test                                                                                 *
I understand by signing/completing this form, my student will be screened daily at school upon arrival by taking his/her temperature and going through a visual screening process. The on-campus screening is in addition to the screening done at home for any of the symptoms listed above. * *
I understand that the Darrington School District has strict cleaning protocols, mask requirements and social distancing expectations. With these protocols in place, I also understand that my student may be inadvertently exposed to germs, illness, sickness (including but not limited to COVID-19) while at school. The school district is following all health and safety guidelines and I agree to not hold the Darrington School District liable or responsible for any sickness/illness that my student may come in contact with. *
By typing my name below, as the legal parent/guardian, I am agreeing to all the terms listed above and following through on daily health checks at home prior to sending my child to school. I understand that this form will be required to be signed digitally before my student attends school (on campus).
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Darrington School District.

Does this form look suspicious? Report

Google Forms