On-Site Learning Agreement (rev. 2/2021)
This form MUST be completed before On-Site Learners may come into the building for the second half of the year, even if a previous form was submitted. Expectations have been updated and should be discussed between the parent/guardian and the student(s). It has also been revised so that one form is now sufficient for the entire family. By submitting the On-Site Learning Agreement online, the parent certifies that the expectations have been discussed with each student who will be coming onsite. We recommend printing a copy of the agreement and posting it in a central location at home, in case questions arise about expectations.

Due to the health and safety risks posed by COVID-19, and in the event of on-site (in the school building) learning, students are required to follow CDC and the Minnesota Department of Health guidelines at all times. These protocols are required to ensure the safest environment possible for students and staff. Each family must discuss these practices and sign off on this agreement before their student(s) will be allowed into the building for second semester.

IF A STUDENT VIOLATES ANY OF THE FOLLOWING EXPECTATIONS, THEY MAY BE REQUIRED TO RETURN TO FULL DISTANCE LEARNING. THE FIRST VIOLATION RESULTS IN TWO WEEKS OF DISTANCE LEARNING, AND THE SECOND VIOLATION MAY BE FOR THE REMAINDER OF THE SCHOOL YEAR.

Hmong Translation: https://forms.gle/bcAcHzynU6rcPcnj7
Spanish Translation: https://forms.gle/LzXuBKHGXnB6RJZr7
Sign in to Google to save your progress. Learn more
Email *
Clear selection
Student #1 First Name: *
Student #1 Last Name: *
Student #1 Grade Level:
Student #2 First Name:
Student #2 Last Name:
Student #2 Grade Level:
Student #3 First Name:
Student #3 Last Name:
Student #3 Grade Level:
Student #4 First Name:
Student #4 Last Name:
Student #4 Grade Level:
Student #5 First Name:
Student #5 Last Name:
Student #5 Grade Level:
Have you discussed all of these agreements with your TCA student(s) *
Required
My student(s) will wear a mask properly (over both their nose and their mouth) while on school grounds and on the school bus, at all times except when eating or drinking, or specifically allowed by a teacher or staff member to remove their mask for another reason (eg. outside Phy Ed activity). *
Required
My student(s) will maintain 6 feet of social distance in all areas of the school building, including hallways, cafeteria, and entering or exiting the building, to the best of their ability. *
Required
My student(s) will go directly from one class to the other during passing time (passing time will be staggered, so all students are not in the hallway at one time).   *
Required
To ensure only one student is in the bathroom at a time, my student(s) will only use the restroom during class with permission from the teacher. My student(s) will wash or sanitize their hands after visiting the restroom, and as planned as part of their classroom routines. *
Required
My student(s) will remain in their assigned seat while on the bus and in the classrooms to maintain proper social distance. *
Required
My student(s) will use a sanitizing wipe to wipe down their work areas in classrooms at the beginning and the end of class. *
Required
My student(s) will follow all other directions given by staff members in regards to health and safety procedures. *
My student(s) will be up to date on all Minnesota required vaccines before coming into the building. Questions about the student’s status may be directed to Ms. Seashore at aseashore@twincitiesacademy.org *
Required
Should my student(s) receive a Covid vaccine, we understand that mask wearing, proper hand hygiene and social distancing will continue to be required on campus and buses until such a time as parents are notified that TCA there is a change in policy. *
Required
My student(s) will be dressed for school warmly enough to be comfortable with windows open on the bus and in the classroom. This may include a jacket, sweatshirt, or sweater to wear indoors over the uniform. *
If my student(s) are showing any kind of illness, I will keep them at home AND contact Arlene Seashore. If one sibling is ill, I will consult with Ms. Seashore before I send other siblings into the building.  aseashore@twincitiesacademy.org *
Required
I have read the following recommendations, and understand that doing these things will help keep my student(s) and other people from becoming ill, both from COVID 19 and other illnesses: *Wearing two masks together on the bus *Maintaining social distancing and proper masking in the community outside the school  *Changing to full distance learning if student has been unmasked or in close contact with someone outside of the house, ill or not                                                                                                                                         *Filling out the emailed  symptom checker the evening before an onsite school day, or in the morning before leaving the house. (One report from a family, which includes the symptoms of all the students, is now considered an adequate report for each on-site day.) *
Required
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of Twin Cities Academy. Report Abuse