Parent / Student Attestation

Daily Pre-screening for COVID-19

Parents are required to attest to the expectations stated below. By choosing SUBMIT at the end of the form, you will confirm that you have read and will abide by the conditions stated. Any student beginning in-person instruction on September 29th must have an attestation form on file.

If you have already signed and sent the form to Y.A.L.E. School via mail or email, you do not need to complete the online form.

Expectations

Parents or Guardians of all students attending YALE School will be required to perform daily pre-screening at home before they leave for school. Daily screening for symptoms and on-going self- monitoring can help to quickly identify illness and help reduce exposure to COVID-19 and other contagious illnesses. Prescreening will also decrease the risk of a sick student needing to be picked up from school.

Parents and students will perform a daily pre-screening assessment prior to the student coming to school each day. Parents, guardians, and caregivers who identify illness symptoms during the daily pre-screening, must keep student home. Parents must call the school (nurse or homeroom teacher) to report any signs or symptoms of illness, or to report any close contact or potential exposure to COVID-19. The student must remain home from school and guidance will be given for the student’s safe return to school.

Directions for Screening:

Carefully review and answer each question. If your child has any symptoms of illness listed below, keep them home. You Do Not need to send this form to school with the student. Call the school health office to report any positive findings.

Covid-19 Symptom Attestation

Check the student’s temperature each morning before school. If the student has a temperature of 100.4 or above, the student must stay home. DO NOT give your child fever reducing medication and send them to school. A temperature recheck will be done on each student when they arrive at school.

Answer the following questions:

Does your child have any of these symptoms?
- Fever
- Chills
- New shortness of breath
- New cough
- New loss of taste or smell
- Nausea/vomiting/diarrhea
- Sore throat
- Muscle or body aches
- Congestion/runny nose
- Fatigue or headache
Has your child had close contact (within 6 feet for at least 15 minutes) in the past 14 days with someone diagnosed with COVID-19, or have you been advised to quarantine?
Since last at school, has your child been diagnosed with COVID-19?
Has your student travelled to any other state that is currently listed on the NJDOH state advisory list?
Have you given your child any fever reducing medications in the past 24 hours?

If the answer is “Yes” to any of the above questions during pre-screening before school, keep student home.

Parent / Guardian Attestation Form

This form does not need to be sent to school each day. Your child will be screened each day at the designated arrival entry to ensure symptom check has been completed. Your child will be sent home if symptoms of illness or other COVID-19 criteria are identified at the school screening checkpoint.

Please use the SUBMIT button to confirm the Attestation Statement below. This form is valid for the 2020-2021 school year. I attest that:

I have read the above statements, will answer each question truthfully and will perform a prescreen assessment on my child prior to sending to school each day.

I will keep my child home if sick, or if he/she has any symptoms of illness or possible COVID-19 exposure, or Close Contact with a person known to have tested positive for COVID-19, or who is experiencing symptoms of the virus.

I will make arrangements to pick up my child immediately if he/she displays any symptoms of illness, including a temperature of 100.4 or higher, upon his/her screening prior to entering school.

I understand that any behavioral or health infraction that might increase exposure to communicable diseases; including fighting, spitting, biting, behaviors requiring restraint, refusal to wear a mask, or maintain social distance, will not be sustainable in the school setting.

I understand that repeated infractions will result in a parent/district meeting which will likely include moving my student to remote instruction for a period of time.

Student Name

Parent's Name

Date

Phone Number

Parent's Email

Print and keep this as a reminder to perform daily Covid-19 prescreening.

Download Checklist