Spencer County Public Schools Parental Assurance for Daily Student Health Assessment 2020-2021
This form MUST be signed and received by Spencer County High School before the student listed below can resume in-person schooling.
Parent/Guardian Email Address
Student First Name
Student Last Name
I agree to perform the following health assessments on a daily basis before allowing my child to attend school in-person or to board the bus for transportation to school:
• Temperature greater than 100.4
• New uncontrolled cough, shortness of breath, or difficulty breathing
• GI symptoms (nausea/vomiting/diarrhea)
• New rash
• New loss of taste or smell
• Fatigue, muscle and/or body aches
• Sore throat
• Congestion or runny nose (non-allergy related)
• Exposure to a COVID-19 case during the prior 48-hour period
I assure Spencer County Public Schools that:
• My child will not attend school on those days if any of these or other known CDC COVID-19 symptoms
• I will notify the school of my child's absence if these symptoms occur.
• I, or my designee, will pick up my child as soon as possible if they develop any COVID-19 symptoms during the school day.
• I am aware that my child (1st grade and older) will be required to wear a cloth face covering or mask on the bus and during the school day.
• I will provide my child with a mask each day and will notify the school if I need help doing so.
• KY Department of Public Health Contact Tracer will notify families IF your child is identified as a close contact of a positive COVID-19 case (NOT SCPS).
Parent/Guardian Name: (by typing my name below I acknowledge that this serves as my electronic signature indicating that I will adhere to the above listed guidelines and requirements)
Never submit passwords through Google Forms.
This form was created inside of Spencer County Public Schools.