Declaration of Intent:  Temporary Distance Learning
Dear Parent/Guardian:

This form should be used by those parents/guardians who wish to have their child stay home full-time rather than attend school in person.  The State of Connecticut has provided for parents to choose to keep their children home if they are concerned about COVID-19.  In order to effectively plan our classroom rosters, we need the following information.

THIS FORM IS ONLY REQUIRED FOR THOSE PARENTS WHO PLAN TO KEEP THEIR CHILDREN HOME EACH DAY FOR TEMPORARY DISTANCE LEARNING FOR ALL OR PART OF THE 2020-2021 SCHOOL YEAR.

Parent/Guardian First and Last Name *
Parent/Guardian Home Address *
Parent/Guardian Contact Phone Number *
Parent/Guardian Email Address *
Student #1 First Name *
Student #1 Last Name *
Student #1 Grade for 2020-2021 School Year *
Student #1 School for 2020-2021 school year *
Student #2 First Name
Student #2 Last Name
Student #2 Grade for 2020-2021 School Year
Student #2 School for 2020-2021 school year
Student #3 First Name
Student #3 Last Name
Student #3 Grade for 2020-2021 School Year
Student #3 School for 2020-2021 school year
Student #4 First Name
Student #4 Last Name
Student #4 Grade for 2020-2021 School Year
Student #4 School for 2020-2021 school year
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