Quarantine Return Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

In planning for your child's return from quarantine, please complete the form below.

Child' Last Name *

Child's First Name *

Student Identification Number *

Child's Grade Level *

What is your child's approved date of return? *

YYYY

Per recent CDC guidance, students who tested positive for COVID-19 may return to school after 5 days of isolation/quarantine provided their symptoms have been resolved and they wear a mask. Realizing these students are also required to distance six feet when not wearing a mask, adjustments will need to be made for your child during breakfast/lunch. Please select one of the options below: *

I give permission for my child to eat in an alternate breakfast/lunch location for the remainder of the quarantine period.

I do not give permission for my child to eat in an alternate breakfast/lunch location. I will instead opt to keep my child home the entire 10 days. Please note: Your child's absences will continue to be excused.

Electronic Signature - Your name below verifies the conditions for your child's return as it pertains to masking and breakfast/lunch. *

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Chesapeake Public Schools. Report Abuse

Forms