Family Attestation Form

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Parents play a critical role in helping to keep Immaculate healthy, safe, and open. Each morning, families agree to use this checklist of symptoms to decide if their child should attend school. If you have answered “yes” to any of the questions, then your child cannot enter the school for the safety of others. By signing this form, you agree to daily health screenings at home, all of our health and safety guidelines outlined in our opening plan. One form per family.

Email *

Student Name #1 *

Student Grade #1 *

Student Name #2

Student Grade #2

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Student Name #3

Student Grade #3

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I agree to check my child for the following symptoms each day before school. If my child has any one symptom from this list, I understand that I must keep my child home that day.

By checking "Yes", you agree to the statement above. *

Yes

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This form was created inside of Immaculate Conception Catholic Regional School. Report Abuse

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