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Covid Consent Form

This document is a parent acknowledgement and consent form for COVID-19 procedures at a preschool and daycare. It outlines the risks of COVID-19 and different risk levels of activities. It details symptoms to watch for and requires parents to notify the school if the student exhibits symptoms or is exposed. Parents must sign to acknowledge understanding the risks of exposure to COVID-19 by attending.

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creativelearnersulwe2018
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27 views

Covid Consent Form

This document is a parent acknowledgement and consent form for COVID-19 procedures at a preschool and daycare. It outlines the risks of COVID-19 and different risk levels of activities. It details symptoms to watch for and requires parents to notify the school if the student exhibits symptoms or is exposed. Parents must sign to acknowledge understanding the risks of exposure to COVID-19 by attending.

Uploaded by

creativelearnersulwe2018
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Parent Acknowledgement cum Consent

Form for COVID-19 Pre-school & Day-care Procedures.


 Please read carefully the following information and sign as to your
agreement and acknowledgement.

Coronavirus disease (COVID 19) is an infectious disease, which is extremely


contagious and believed to be spread very quickly by person-to-person
contact, and/or by contact with contaminated surfaces and objects, and
possibly in air. In order to prevent the spread, health agencies highly
recommend social distancing.
Regarding school activities:

Lowest risk: Students and instructors engage in only virtual classes,


activities and events.

Medium risk: Small size classes, activities and events. Groups or


students remains the same, get in the class with the same instructor,
and groups do not mix.

Highest risk: Full sized classes, activities and events. Students mix
between classes and activities.
The school administration has taken necessary precautions to prevent
spreading COVID-19 by putting into action new procedures, protocols and
policies and purchased required protective safety equipment for the students
and instructors. On the other hand, the school administration cannot
guarantee that the students will not be exposed to COVID-19. Moreover,
attending schools increase the risk of contracting COVID-19 for the students.
By signing the agreement and acknowledge for, I, as a parent/guardian of the
student,_______________________ age, ____ acknowledge the contagious
nature of COVID-19 and voluntarily accept the risk that the student may be
exposed to or infected by COCID-19 throughout the school and day-care
activities, which may result in personal injury, illness, disability, or even death.
I understand that the students may be in contact with the instructors, offices,
and/or the other students who are also at the risk of community exposure.
I fully understand that any precaution is not 100% effective to prevent COVID-
19 infection.
I understand that I am responsible for the student to be free from any kind of
COVID-19 symptom before participating in any school activities. These
symptoms are as following:
 Fever of 100.4 degrees or higher
 Dry cough
 Shortness of breath
 Chills
 Loss of taste or smell
 Sore throat
 Muscle aches
 Any other symptom identified by WHO
I understand that I will immediately notify school management if I become
aware any person whom the student or anyone in the family has had contact
demonstrate any of the symptoms mentioned above, or is advised to self-
isolate, or has tested positive, or is assumed to be COVID-19 positive.
By signing this form, I certify that I have read and understood the risk of
COVID-19 infection that the student will be exposed throughout the days in
school.
Student’s Name(full): -

Parent’s/Guardian’s Name(full): -

Parent’s/Guardian’s Signature: -

Note: Attest a copy of Aadhar card


Address of Preschool & Day-care:
Creative Learners Preschool, Sohamdeep Building, Shop no. 1 & 2, Plot no. A11,
Sector-8, Ulwe, Navi Mumbai, 410206.

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