Health Screening Certification

PLEASE READ AND ACKNOWLEDGE THE FOLLOWING HEALTH AND SAFETY SCREENING GUIDELINES BEFORE RETURNING TO IN-PERSON INSTRUCTION AT THE BEGINNING OF THE SCHOOL YEAR (Please note: this acknowledgement only needs to be submitted once, not daily. You may be required to submit this again before returning from Christmas break prior to the start of the new calendar year)

If your child(ren) has ANY TWO of the following symptoms listed below from fever up to diarrhea or ONE of the last four symptoms listed from cough down to loss of taste/smell they should be PCR tested before returning to school, this indicates illness which may decrease your child’s ability to learn and also puts them at risk for spreading illness to others.

Your child(ren) must be checked for these symptoms each day BEFORE arriving at school. If any of these symptoms are present, he/she may not come to school. They must be symptom free for 72 hours to return to school.

NOTE: If your child has seasonal allergies, please provide a note from your pediatrician stating this so that staff and administration do not mistake this for symptoms of illness.

By checking this box I agree to random temperature checks of my student(s) by St. Bernadette staff during the school day REQUIRED I agree Please fill out this field.

Name of Student #1 REQUIRED Please fill out this field. Please enter valid data.

Name of Student #2 (if applicable) Please enter valid data.

Name of Student #3 (if applicable) Please enter valid data.

Name of Student #4 (if applicable) Please enter valid data.

Name of Parent/Guardian REQUIRED Please fill out this field. Please enter valid data.

Health Screening Certification REQUIRED By checking this box I acknowledge that I have read and understand the information presented above and agree to follow these procedures and guidelines to sustain a healthy and safe school environment for all students attending St. Bernadette School. Please fill out this field.

St. Bernadette School

Leading in Innovation Learning in Faith

Health Screening Certification

Health Screening Acknowledgement (Required)