December - Parent Responsibility COVID Questionnaire
Please be sure to complete 1 FORM PER CHILD. By completing this form, I will only send my child to school if:

- They are feeling healthy and well and do not have a temperature of 100F or higher. (

- Within the last 14 days, they have not been in close contact with anyone who has been diagnosed with COVID-19.

- Within the last 14 days, they have not tested positive for COVID-19 or been diagnosed as COVID-19 positive by a healthcare provider.

- They have not traveled to any state (other than Connecticut, Massachusetts, New Jersey Pennsylvania or Vermont) without completing the COVID test requirements as set forth by New York State as of November 4, 2020, which requires a negative COVID test no more than 3 days prior to leaving my destination, mandatory 3-day quarantine upon return to New York and a negative COVID test on the 4th day prior to entering this building.

- They have not traveled internationally without completing a mandatory 14-day quarantine.

If these guidelines change or are updated by NYS or the federal government, it is your responsibility to adhere to the most recent active regulations.

If at any point, you do not meet the criteria for any of these questions, please DO NOT SEND YOUR CHILD TO SCHOOL and contact the School District immediately.
Student First Name *
Student Last Name *
School *
Grade *
By clicking this button, I attest to the above information and only send my child to school if they meet the criteria listed above. *
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