COVID-19 Acknowledgment and Consent- Daily Screening
2021-2022 School Year

Dear Parents/Guardians,

In order to keep our schools safe, health screenings are a necessity for students when entering the school building. All parents/guardians must certify that they will self-screen their child before reporting to school EACH morning. In completing and signing off on this form, you certify that you are completing the necessary daily screening prior to your child leaving home and reporting to school. You will need to complete this form for each child that you have enrolled in the district.

We look forward to bringing our students back for the new school year!

-New Providence School District
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Email *
Parent/Guardian First Name *
Parent/Guardian Last Name *
Student's First Name *
Student's Last Name *
School *
Signs and symptoms of COVID-19 in children may be similar to those of common viral respiratory infections or other childhood illnesses. Symptoms may appear 2-14 days after exposure to the virus and include the following: (2 or more of the following) Fever or chills; Fatigue; Muscle or body aches; Headache; Sore throat; Congestion or runny nose; Nausea or vomiting; Diarrhea; (1 or more of the following) Cough; Shortness of breath or difficulty breathing; New loss of taste or smell.
By clicking below, I certify that I understand it is my responsibility to self-screen my child for a temperature (>/= 100.4) and any COVID like symptoms each day prior to leaving home and reporting to school: *
Required
By clicking below, I certify that I understand my child will be required to wear a face mask at all times during the school day and all school activities, expect when participating in school athletics and unless specified otherwise or unless doing so would inhibit the student's health. *
Required
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