Humansville R-IV 20-21 Registration Acknowledgement Form

The Coronavirus pandemic has introduced a new level of risk for in-person instruction and in-person gatherings. As we plan for the upcoming school year at the Humansville School District (the “District”), we recognize that our instruction and programming is likely to be affected by the pandemic. Our primary priorities will always be to provide an environment that is as safe as possible for children and staff, and to continue to offer high quality educational opportunities for our students. For the start of the school year and with an understanding of the possible impact the pandemic can have on our community, the District is asking families to review and complete this Acknowledgement Form. The document outlines our shared expectations for the return of students and in-person instruction at our schools.

I will immediately notify the District if my student is required by a health official to seek COVID-19 testing or if my student tests positive for COVID-19.

My student will not attend school if my student is experiencing two of more of these symptoms potentially related to COVID-19, including:

A fever (100.4 F or higher), or a sense of having a fever,
A new cough that cannot be attributed to another health condition,
A new shortness of breath or difficulty breathing that cannot be attributed to another health condition,
Any loss of sense of smell or taste,
A new sore throat that cannot be attributed to another health condition,
New muscle aches that cannot be attributed to another health condition, or that may have been caused by
a specific physical activity,
Chills or shaking with chills, or
Headaches that cannot be attributed to another health condition.
Email *
Student Last Name *
Student First Name *
Parent/Guardian Name: *
Today's Date *
In the event of virtual or on-line learning, does your home have reliable high-speed internet (excluding cell phone hot spot)? *
How many working internet capable devices (excluding cell phones) do you have in your home? (examples: laptop, desktop) *
My student be starting the 20-21 school year with: *
A copy of your responses will be emailed to the address you provided.
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