COVID-19 Student Health Attestation
Please review the Student Health attestation and indicate your agreement by returning a signed copy to your child's school or submitting this form by Wednesday, January 20, 2021
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Student Name *
School/Program *
I certify that I am the legal parent or guardian of the above-named student and I have read and fully understand this Health Attestation and agree with its terms. *
Parent/Guardian First Name *
Parent/Guardian Last Name *
Date *
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Student Health Attestation
Union County Educational Services Commission continues to implement enhanced health and safety protocols to ensure positive learning environments for students, staff, and families during the COVID-19 pandemic.  
 
In order to assist with our efforts, we ask all parents and guardians to indicate their agreement with the following revised procedures for daily school admittance reflecting current guidance from the NJ Department of Health and the Westfield Regional Health Department:    
 
Parent/Guardian Attestations:
 
1. I will send my child to school with an appropriate face covering on a daily basis.  

2. I will make arrangements for my child to be picked-up from school in a timely manner
        and comply with recommendations for school readmittance as directed by the
        Principal and/or School Nurse.

 3.   I will keep my child home and immediately contact the School Nurse when my child:

                 a. Demonstrates any of the following COVID-19 compatible symptoms:  
                               i. Fever (100.4° F or greater)
                               ii. Difficulty Breathing or Shortness of Breath
                               iii. Cough, Congestion or Sore Throat iv. Loss of Taste or Smell  
                               iv. Nausea, Vomiting or Diarrhea  
                               vi. Headache or Muscle Ache  
 
                b. Experiences any of the following potential exposures to COVID-19 within the
                       past-14 days:  
                               i. Your child or a member of your immediate household tested positive
                                      for COVID-19 or are currently demonstrating COVID-19 compatible
                                      symptoms.  
                               ii. Your child or a member of your immediate household came into close
                                      contact (within 6 feet of an infected person for 15  minutes during a
                                      24-hour period) with a person  who tested positive for COVID-19 or
                                      who is demonstrating COVID-19 compatible-symptoms
                               iii. Your child or a member of your immediate household was advised
                                      to self-isolate or self-quarantine by a medical professional or public
                                      health official with the past 14-days.  
                               iv. Your child or a member of your immediate household traveled to any
                                    U.S. State or territory beyond the immediate region (New York,
                                    Connecticut, Pennsylvania, and Delaware).

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