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Attestation for Return to School/Childcare
Parents/Caregivers,
Please complete this form to document that your child can return to school/childcare.
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* Indicates required question
My child failed the Ontario COVID-19 school screening tool or was sent home from school/ childcare on:
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MM
/
DD
/
YYYY
My child may return to child care/school on:
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MM
/
DD
/
YYYY
My child may return to child care/school for the following reason:
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Please check all the boxes that apply.
My child has been told they can return to school/childcare by their health care provider and/or Hamilton Public Health Services (HPHS).
My child received a letter dismissing their cohort from school and it has been at least 10 days since the date of last exposure to the positive case.
It has been at least 10 days since the date of exposure to a positive COVID-19 case outside of school or to a symptomatic individual who was not tested for COVID-19.
My child has completed their 14-day quarantine period since traveling internationally.
My child has passed the COVID-19 Ontario School and Childcare Screening today.
Required
Child's Name:
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Your answer
Name of Parent/Guardian Completing this Form:
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Your answer
Date of Form Completion:
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MM
/
DD
/
YYYY
By confirming this attestation, you are confirming the information is accurate to the best of your knowledge.
*
I confirm that the information on this form is accurate to the best of my knowledge.
Required
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