CMCB COVID-19 Health & Safety Pledge
In order to keep our community safe and healthy, all students, parents, caregivers, faculty and staff entering our buildings are required to read and sign this pledge for the 2020-2021 school year.

Please share this form and the CMCB COVID-19 Guidelines and Protocols with any caregivers bringing your child(ren) to CMCB.

Please provide the email address of the person completing this form.
Email *
Please let us know who you are by selecting one of the following: *
Please provide the name(s) of the parent(s) or guardian(s) completing this form. If not applicable, please write N/A. *
Please provide the student(s) name(s). If not applicable please write N/A. *
I agree to wear a mask covering my nose and mouth at all times when in CMCB. Masks are required for all individuals over the age of 2, per CDC guidelines. *
I agree that I will stay home if I am not feeling well. *
I will not come to CMCB if I or anyone in my household has experienced any COVID-19 symptoms in the last 72 hours.
If I or anyone in my household tests positive for COVID-19, and I have been in CMCB in the last 14 days, I will notify one of the CMCB Workplace Coordinators - Meghan Jasani ( or Michael DePasquale ( *
If there is an active diagnosed COVID-19 case with whom I am in regular contact, or if I have been exposed to a diagnosed individual within the last 14 days, I will not enter CMCB. *
I agree to keep a social distance (at least 3 feet, ideally 6 feet) when moving around CMCB. *
By entering my name below, I hereby confirm I have read and understood CMCB's "COVID-19 Guidelines and Protocols", and will abide by them for myself, my children and any caretakers accompanying my children (if applicable). *
Never submit passwords through Google Forms.
This form was created inside of Community Music Center of Boston. Report Abuse