Return to PCCC after being sick

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Please complete this form when your child is returning to PCCC after being home due to sickness. We need accurate information for the center to report to the Department of Health if it is needed. Thank you for taking the time to complete this form. We are praying for your child's health and your family.

**With COVID-19, symptoms need to be improved and fever-free for 24 hours, and may need to be home for a minimum of 10 days. Please review the WA Department of Health Decision Tree posted on our FB page for more details: www.facebook.com/PullmanChristianChildcareCenter

Parent/My Full Name: *

My child(ren)'s First Name: *

Please indicate if your child has been SYMPTOM-FREE for a minimum of 24 hours from any of the following symptoms that cannot be attributed to another condition: *

NONE of the above; My child has been symptom-free for over 24 hours.

My child HAS had at least one symptom AND has a doctor's note allowing my child to return. (My child IS ABLE to return to PCCC care)

My child HAS had at least one symptom: ((Cough, Shortness of breath or difficulty breathing, Sore Throat, Diarrhea, Vomiting, Unusual Fatigue, Cloudy or non-clear runny nose, Intense headache or migraine, Unexplained muscle or body ache, or loss or taste or smell)) (If you select this, then your child is unable to return)

Anyone in the household with any above signs, has a high-grade fever over 100.4*F, or being tested for or suspected of having COVID-19? *

Yes (this requires my child stays home)

In the last 24 hours has your child had a fever of 100.4*F or greater? If yes, have you given your child fever-reducing medication in the last 24 hours? *

NO fever or fever-reducing medication in the last 24 hours

Yes, over 100.4*F and Yes, medication given (my child will need to stay home until they are 24 hours free of fever AND medication)

Yes, over 100.4*F and No medication (my child will need to stay home until they are 24 hours free of fever AND medication)

Please indicate if your child was out from any other symptom not listed above (such as chickenpox, croup, hand-foot-and-mouth, lice, etc.) and is now symptom-free. *

Symptom-free

Not symptom-free (and will need to stay home before returning)

In the last 14 days has your child had close contact with anyone suspected or confirmed with COVID-19? (Close contact is defined as being 6-feet or closer for more than 10 minutes or having direct contact with fluids from a person.) *

Yes (my child will need to stay home)

I certify that if my child was tested for COVID-19, I have notified PCCC of the results. *

I acknowledge the above statement has been read and will be followed.

I certify that if a member of my immediate family (household) was tested for COVID-19, I notified PCCC the results. *

I acknowledge the above statement has been read and will be followed.

I certify that, within the last 14 days, a public health or medical professional has not told my child or an immediate family member (household) to self-monitor, self-isolate, or self-quarantine because of concerns about COVID-19 infection. (If your doctor has removed the quarantine restriction due to a negative COVID test, your family can return.) *

I acknowledge the above statement has been read and will be followed.

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