Acknowledgment of On-Site School Instruction Option at Challenger
You are receiving this form because you have shown interest in attending the hybrid model for on-site learning at Challenger starting April 12, 2021.
Student School ID (6 digit number)
Student's Last Name
Student's First Name
Name of parent/guardian completing this form
Best email to reach parent/guardian
Best phone number to reach parent/guardian
Acknowledgment of On-Site School Instruction Option
San Diego Unified School District (“District”) continues to work with public health authorities, medical professionals, and scientific experts for a safe responsible reopening in light of COVID-19 pandemic1. For updates, please visit
, which includes a weekly tracker on positive COVID-19 cases for students and staff.
The District is offering both on-site and off-site instruction. If you select on-site instruction, please review the requirements below. Then please read, sign, and return this form prior to entry onto a school site.
Completion of this Acknowledgment is mandatory for on-site learning. If you do not return this completed form to your school’s office prior to the start of on-site instruction, your child will continue with off-site instruction. Thank you for your understanding and cooperation during this challenging time.
On-site Instruction Option: Requirements of Parents/Guardians and Students
Although the District has undertaken great efforts to make on-site instruction safe, risks of unmeasurable magnitude remain in that students may contract the virus that causes COVID-19 in a school setting. For students with underlying health conditions or who live in a household with a family member who is at high risk, parents’/guardians’ have the responsibility to consult their own healthcare provider as to whether attending on-site instruction is in the students’ best interest.
By selecting on-site instruction, you and your child are committing to join District staff in abiding by the current public health orders, requirements, rules, regulations, and guidelines, all of which may be amended from time to time, as directed by the California Department of Public Health, San Diego County Public Health Department, the District, and other government authorities with competent jurisdiction (individually or collectively as “Rules”), to reduce the spread of the COVID-19 virus. These Rules include, but are not limited to, the following:
Screen the student at home before school entry for common symptoms of COVID-19 such as congestion or runny nose, coughing, sore throat, shortness of breath or difficulty breathing, muscle or body aches, fatigue, headache, vomiting or nausea, diarrhea, new loss of taste or smell, and/or fever or chills (individually or collectively as “Symptoms”);
Stay at home if the student exhibits Symptoms according to the Rules or if student is considered to be infectious, according to the Rules;
Stay at home if the student has had close contact, within 14 days, to a person who, at that time, was confirmed or suspected to have COVID-19, or directed to quarantine according to the Rules;
Maintain appropriate physical distancing, according to the Rules, relative to operations of a school day, including but limited to, modified access for entry/exit; use of restrooms; eating/drinking; and transportation services for those who qualify;
Ensure the student wears face covering, mask, or other protective facial gear over nose and mouth, unless exempted and documented in the student’s individualized school health plan, under a case-by-case basis through the District case management team.
Understand that a student who might require certain medical interventions during the school day that are deemed to be potential exposure hazards to COVID-19 may be subject to certain restrictions;
Require hand washing/hand sanitizer under the Rules;
Act as, or designate, emergency contact responsible for promptly picking up the student if the student exhibits Symptoms at school;
Limit site access only to essential visitors under the Rules;
Meet requirements for return to school site after experiencing Symptoms, infection, positive testing, or quarantine, as defined under the Rules. For example, this may include evidence of an existing medical condition, staying home for a longer period of time, vaccination status or test results, when requested by District health staff. District health office staff may need to and shall be permitted to interact with the student’s qualified health care professionals for any clarification.
You are also committing to, and providing assurance that, you and your child will abide by the Rules for attendance at a California public school. Please direct specific questions regarding the Rules to your school site administrator.
Breaches of the Rules may result in a change from on-site instruction to off-site instruction for a specified period of time.
After reading all the above information, please select one of the following.
YES, I want my student to participate in the hybrid/on-site program at Challenger.
NO, I DO NOT WANT my student to participate in the hybrid/on-site program at Challenger.
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This form was created inside of San Diego Unified School District.