PLEASE COMPLETE BY WEDNESDAY, SEPTEMBER 1, 2021

This ONE-TIME agreement will remain in effect through the conclusion of the 2021-22 school year unless otherwise indicated by the District.

I acknowledge the expectations and responsibilities as parent/guardian of the student(s) indicated below and ensure that I will perform symptom screenings of my child(ren) each day prior to allow them to board the school bus or before I drop them off at school.  

I further acknowledge that I will keep my child(ren) home if they exhibit any of the symptoms indicated below or if any of the scenarios below are applicable.  If so, I will notify the school immediately and follow all policies and procedures as indicated through the District Learning Plan, Illinois Department of Health, the Local Health Department and the Illinois State Board of Education.  Medical evaluation and testing are strongly recommended for ALL persons with COVID-like symptoms.  A copy of the District Learning Plan is available on the District website www.dimmick175.com under the “Parent” tab.  

Fever of chills
Cough
Fatigue or tiredness from unknown cause
Shortness of breath or difficulty breathing
Moderate to severe headache
Sore throat
Diarrhea
Loss of taste or smell
Muscle or body aches from unknown causes
*Congestion or runny nose (IDPH only)
*Nausea or vomiting (IDPH only)
**Conjunctivitis (CDC only)
**A rash on skin, or discoloration of fingers or toes (CDC only)
**Chest pain or pressure (CDC only)
**Loss of speech movement (CDC only)
Someone at home tested positive for COVID-19
Have been determined to be a “close Contact”
Someone at home is awaiting the results of a COVID-19 Test