Self Certification to Return to School

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Complete this form after an isolation or quarantine due to a COVID-19/Coronavirus Event. You must receive approval prior to returning to school.

Email *

School *

Student Last Name *

Student First Name *

Please indicate your role *

Parent

Legal Guardian

Date Requested to Return to School: *

YYYY

Student is a CLOSE CONTACT to an individual who has tested positive for COVID-19. *

Yes

N/A (I am not a CLOSE CONTACT to an individual testing positive for COVID-19)

Last date of contact with an individual who has tested positive for COVID-19. (Write N/A if not a close contact).

(CLOSE CONTACT OUTSIDE HOME QUARANTINE) If you answered "YES" to the above question, please review the QUARANTINE OPTIONS. Please SELECT ONLY ONE QUARANTINE OPTION in which you are in agreement upon. The following recommendations are provided so that you may take the proper actions to protect your family and others: *

OPTION 1 - OUTSIDE HOME CLOSE CONTACT (10 DAY QUARANTINE) Parent/Guardian "AGREES" that the student followed and completed the 10 DAY Quarantine as recommended by CDC/DHEC.

OPTION 2- OUTSIDE HOME CLOSE CONTACT (5 DAY OPTION TO SHORTEN) Parent/Guardian "AGREES" that student will wear a mask for the remaiOPTION 2- (5 DAY QUARANTINE) Parent/Guardian "AGREES" that student will wear a mask days 6-10 at all Lancaster County School District Facilities and/or events, follow physical distancing guidelines, monitor for symptoms daily and will report any symptoms that develop to the school nurse and will not report to school. I "AGREE" to provide a Negative PCR(Strongly Encouraged) or Antigen (Acceptable) COVID test administered no earlier than day 4 of quarantine.

N/A (I am not a CLOSE CONTACT to an individual testing positive for COVID-19)

(CLOSE CONTACT INSIDE OF THE HOME QUARANTINE) If you answered "YES" to the above question, please review the QUARANTINE OPTIONS. Please SELECT ONLY ONE QUARANTINE OPTION in which you are in agreement upon. The following recommendations are provided so that you may take the proper actions to protect your family and others: *

OPTION 1- INSIDE HOME CLOSE CONTACT (15 DAY Quarantine) Parent/Guardian "AGREEs" that the student followed and completed 10-day quarantine as recommended by CDC and DHEC

OPTION 2- INSIDE HOME CLOSE CONTACT (10 DAY OPTION TO SHORTEN) Parent/Guardian "AGREES" that student will wear a mask for the remaining days of the 15-day quarantine. Parent/guardian will continue to monitor student for symptoms of COVID-19 daily. If symptoms develop, parent/guardian will notify the school nurse and student will not report to school.

N/A (I am not a CLOSE CONTACT to an individual testing positive for COVID-19)

Date Student Tested for COVID-19 (N/A if not tested) *

Date Student began experiencing symptoms of COVID-19 *

YYYY

Result of COVID-19 test *

Positive

Negative

Not tested

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