Community Agreement & Consent Form
The 2021 Summer Program will be distinctively different from past years, but Fairfax Collegiate is focused on providing a safe and healthy environment for students and staff to learn and teach.

We are taking multiple precautions to protect our students and staff, however, please understand that even with these new protocols, Fairfax Collegiate can’t entirely eliminate health risk.

We ask our community - students, teachers, and parents - to work together toward the common goal of keeping our community safe. We rely on families to set the tone at home for how we can support one another this summer. We know that as our partner, you will lead with a sense of calm, composure, and preparedness, setting an example for your children and for the community at large. We thank you for your support as we prepare to welcome your children to the Summer Program.

For any questions about this form, please contact or call (703) 481-3080. You can also find more information about COVID-19 at

A PDF copy of this form is available at:
The list of our safety procedures is available at:

A copy of your form will be sent to the email address you provide below (which can be different than the email address on your Fairfax Collegiate account if desired).
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Email *
Fairfax Collegiate Account Email Address *
Please provide the email address associated with your account on the Fairfax Collegiate website. Please carefully double-check the spelling so that we can keep accurate records of who has completed the Community Agreement & Consent Form.
Adult *
Please confirm the first and last name of the adult filling out this form.
Children *
Please confirm the first and last name of each child who will be attending the in-person Summer Program.
Assumption of Risk *
Parents understand and acknowledge that certain risks are inherent to COVID-19 and voluntarily assume such risks, whether described herein, known or unknown, inherent or otherwise, and take full responsibility for any injury or loss their family may suffer arising in whole or in part from COVID-19 and their child’s attendance of the Summer Program.
Responsibility for Health Screening 1 *
Parents affirm that their children’s presence at the Summer Program on any day means that they have assessed their children and affirm that they are free of COVID-19 symptoms (per CDC guidelines: fever or chills, cough, shortness of breath, fatigue, muscle or body aches, headache, new loss of taste or smell, sore throat, congestion or runny nose, nausea or vomiting, diarrhea).
Responsibility for Health Screening 2 *
Parents understand and agree that on any day when their children exhibit symptoms, their children are not permitted to attend the Summer Program.
Need to Inform and Quarantine *
Parents agree to inform Fairfax Collegiate as soon as possible after learning of their/their child’s suspected or confirmed positive case of COVID-19 and/or the need to quarantine due to living with or having close contact with a person suspected or confirmed positive for COVID-19.
Liability Waiver *
Parents voluntarily waive and release any claim of liability against Fairfax Collegiate, its affiliates, officers, directors, employees, and representatives, and expressly agree to hold harmless the same from any claims related to COVID-19 in connection with their child’s attendance of the Summer Program, to the fullest extent permitted by law.
Safety Committment *
As members of the Fairfax Collegiate community, we agree to support the health and safety of our community by following the COVID-19 Safety Procedures ( - opens in a new tab) each day.
Electronic Signature *
By typing your full legal name, you acknowledge that your typed name constitutes a legal signature confirming that you acknowledge and agree to the above terms.
A copy of your responses will be emailed to the address you provided.
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