This form is intended for our families to commit reporting, if any COVID related symptoms or situations occurred within your family.

Our student’s health and safety is a top priority.

By accepting this form, entering your family information including your children attending Faith Formation Program Classes, you ( parents/guardians) are here by consenting the following:-

1. If  your child or any member of your household experienced any of the following new and unexplained symptoms?  Symptoms Include:  (Fever of 100.4 or higher, as measured without fever reducing medicine, Cough, Shortness of breath or difficulty breathing, Chills, Muscle or body aches, Headache, Sore throat, Loss of taste or smell , Fatigue, Chest/Nasal Congestion or runny nose, Nausea or vomiting, Diarrhea) before the day you are scheduled for in-person Classes.

2. Any of the additional criteria pertain to your child or other members of the household? a) My child or household member has been in close contact with someone with COVID-19 within the last 14 days, OR b) A government agency or physician has advised my child or household member to isolate or self-quarantine, OR c) My child or household member has symptoms not listed above, that local guidance indicates should exclude your child from entering the school premises.


3. If before, the last 10 days, if your UNVACCINATED child or household member traveled outside of the USA or to any state outside of the immediate area (PA, DE, NY) for a duration longer than 24 hours?


I Consent that I will consult/notify the Church Health and Safety Team or submit the Health Notification Form prior to gain access to the in-person classes.