CASA Transportation Protocol Agreement

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By completing and submitting this form, you are acknowledging that you have received and read the Transportation revision to CASA of Santa Cruz County's COVID19 In-Person Visit Guidelines effective June 1, 2021.

June 1 Transportation Revision:
https://drive.google.com/file/d/198n5nobAROl9QB0ASXfbtT5BqT-SlBNL/view?usp=sharing

Original In-Person Visit Guidelines: https://drive.google.com/file/d/1TD4veKyFlUAeTtGf0AtFfg6Ipzxo0Acx/view?usp=sharing

I agree to the following: *

I accept the risks associated with visiting in-person and driving my CASA child/youth.

Required

I agree to the following: *

I agree to follow the protocols outlined in this document, as well as local guidelines

Required

I agree to the following: *

I will forgo in-person visits and/or transportation of my CASA child/youth if the child/youth, caregiver, or my Supervisor, or I, myself are not comfortable with any part of the proposed arrangement.

Required

We're taking a poll about who might want CASA to put together a "Car Kit" (to include hand sanitizer, child-size reusable mask, extra adult size disposable masks, disinfectant wipes, gloves & garbage bags in a small box/caddy to keep in your car). Could you indicate what would be best for you? *

I have my own supplies

I will buy supplies and send my receipt to my supervisor for up to $20 reimbursement

I would like to pre-order a CAR KIT

Name of Advocate *

Date Signed *

YYYY

Advocate Signature *

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