Permission Form A: In-Person Theatre

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Please complete this form in order for your child to safely participate in our in-person theatre opportunities during Whodunnit. Email me with any changes or questions after submission.

What is your name & relation to the HHS student? *

What is your child's full name? *

What grade are they in? *

My child has the following allergies or medical conditions. (Please be specific or write "none".) *

What is your child's T shirt size? (This is for the production shirt.) *

Adult Small

Adult Medium

Adult Large

Adult XL

Adult XXL

Please check the following you agree with for this 20-21 school year. If you are uncomfortable with a certain platform, please complete the "other" choice with as much detail as possible. Thank you! *

I give permission for my child to be screened for COVID_19 symptoms, including but not limited to frequent temperature checks.

I understand and agree that if my child does not follow protocols that they may be sent home for safety reasons. I also understand that if my child deliberately does not follow the recommended guidelines and procedures that they may be excused or dismissed from the extracurricular program entirely.

I understand and agree that if my child is showing any of the following symptoms, they may be asked to go home. These include, but are not limited to fever or chills, cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, headache, new loss of taste or smell, sore throat, congestion or runny nose, nausea or vomiting, diarrhea, persistent pain or pressure in the chest, new confusion, inability to wake or stay awake, bluish lips or face, etc. Therefore I know my child must be checked for symptoms, participate in routine temperature checks, and be “cleared” as safe for each in-person meeting. If they meet any of the criteria for showing symptoms, I understand that they will be sent home.

I understand and agree that my child should adhere to the guidelines as per local regulations and safety measures. These include, but are not limited to, those listed on this form.

I understand that my child must comply by wearing a mask at all times (with a clear section over the mouth during filming when possible for best communication).

I understand that my child must comply by standing 3-10 ft apart at all times when others are present, especially in indoor settings or following the Virginia Guidelines for social distancing with a mask.

I understand that my child must comply by standing 10 ft apart when not on set filming/acting at all times.

I understand that my child must comply by taking breaks for water and mask relief outside when possible (weather permitting), yet maintain safety standards and protocols even while outdoors.

I understand that no individuals outside of the production (either staff or student) will be permitted to physically interact with the students or staff during their time on the Heritage campus.

I understand that during pick-up and drop off, all persons must remain in their cars until called for a health and temperature check.

I understand that volunteers and staff will implement the following prevention and mitigation strategies to slow and limit COVID-19 exposure and spread but that there is still no guarantee to prevent the spread during the production: Cover your cough, Wear gloves throughout the process, Practice recommended regular and routine hand-washing practices in the event of glove malfunction or when visiting the restroom, Avoid use of items that are not easily cleaned and disinfected, Practice proper use, removal, and washing of cloth face coverings, Post signs with Covid-19 prevention and control practices, Provide policies and education on COVID-19 prevention and control practices, Ensure adequate supplies of tissues, hand soap, alcohol based hand sanitizer and household cleaning products suited for the facility, and other safety protocols.

I understand that any staff member or child exposed to a person diagnosed with a confirmed or probable case of COVID-19 may not work or return to the production until they complete self-quarantine following the CDC Guidelines. Persons who have recovered from COVID-19 must be cleared for release from isolation according to CDC Guidelines.

I understand that if my child exhibits any signs or symptoms of COVID-19 or any potentially contagious illness, I will keep them home.

I will read through the other protocols and procedures and agree to adhere to them as best as we as families can.

I also understand that before my child enters the building we should assess their health using the following questions: Do you have a temperature of 100°F or above? Do you have a new cough, shortness of breath, or new sore throat that cannot be attributed to another health condition? Do you have gastrointestinal symptoms, including nausea, vomiting, or diarrhea, that cannot be attributed to another health condition? Do you have new nasal congestion, a new runny nose, or a new loss of smell or taste? Do you have new muscle aches or any other sign of illness? Have you had contact with someone in the previous 14 days with either a confirmed diagnosis of COVID-19 or who is ill with a respiratory illness?

If the answer to any of these questions is yes, I understand that my child should remain at home and that if my child or someone else at home have had a positive COVID test in the past 14 days and/or have had a fever in the last 3 days, that they remain at home.

Required

I understand that there is still risk involved in meeting in person and I am willing to take that risk, given Heritage's LCPS approved safety measures in place. *

Yes

By typing my full name below: I understand that the staff and volunteers are working to the best of their ability to keep the students safe, but there is no guarantee that they can prevent the spread of COVID-19 and/or any other viruses. By signing this agreement, I additionally acknowledge and assume the risk of exposure or infection that my child(ren)/family/heirs/representatives and I may experience. I will not hold the staff, school or volunteers responsible, but rather will support Heritage's efforts to maintain safe, educational experiences for the duration of this project and beyond. (Please type your full name below). *

By typing my full name below: I understand that if I answered no or did not check one of the boxes, my students might not be able to participate in this production. (Please type your full name below). *

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