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NOTIFICATION AND RELEASE OF LIABILITY JL LONG PTA 8th Grade Picnic
J.L. Long PTA wishes to inform all potential attendees of the risk of COVID-19 exposure associated with attendance at the J.L. Long 8th Grade Picnic. J.L. Long PTA will adhere to enhanced procedures to minimize this risk and prevent the spread of COVID-19. Please complete and submit the following questionnaire for your 8th grade student who will be attending the picnic.
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8th grade student's name:
*
Your answer
Is your student experiencing any symptom of illness such as cough, shortness of breath or difficulty breathing, fever, chills, repeated shaking with chills, muscle pain, headache, sore throat, or new loss of taste or smell?
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No
Yes
Has your student traveled internationally within the last 14 days?
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No
Yes
Has your student been diagnosed with Coronavirus/Covid-19 and not yet cleared as non-contagious by state or local public health authorities?
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No
Yes
Has your student followed all CDC recommended guidelines as much as possible and limiting my exposure to the Coronavirus/COVID-19?
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Yes
No
By entering my name below, I agree to each statement above and release J.L. Long Middle School, J.L. Long PTA and the City of Dallas, its officers, agents and employees from any and all liability and all claims, lawsuits, judgments, costs and expense for the unintentional exposure or harm due to COVID-19.
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Your answer
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