Clayville Elementary School Parent/Guardian RETURN TO SCHOOL Attestation
Please read carefully. This is information in regards to screening your child for COVID-19 AFTER illness prior to returning to school. Your signature at the bottom acknowledges you have read and understand this information.

*** A form must be completed for each child.***

This Attestation will be available on the district site for your signature prior to return of your child after illness. Our school nurse and secretary will collaborate to ensure each child has a completed Attestation form daily. The safety of our students, staff, and school community are our top priority.
First Name *
Date of Birth *
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Phone number *
Date of absence(s) *
Which of these symptoms were experienced? Please check all that apply.
Date symptoms began: *
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Date symptoms ended *
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Was the student/staff member tested for COVID? *
If no, why not?
If yes, when and where was the test completed? *
What was the result of the test? *
Date isolation concluded: *
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Comments
Your Signature

I attest that the student is ready to return to school and has:
-Not had a fever (temperature higher than 100.4°) in the last 24 hours
-Not taken any medicine for fever in the last 24 hours
-Improved symptoms and is back to usual h
First & Last Name (this will note as your signature) *
Today's Date *
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After-Illness Return Attestation: The questions on this form were generated directly from this form from RIDE and RIDOH. Thank you for your cooperation.
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