Attestation to Return After an Illness or Exclusion (March 10 2021)

Attestation for return to Before/After School or Child Care following illness, exclusion or self-isolation

Please complete this form to document that it is safe for your child to return to our Before & After School programs, or Early Learning Child Care program at Waterdown District Children’s Centre.

If you do not feel comfortable using this online form, then you may complete the school board's PDF attestation here (https://www.hwdsb.on.ca/wp-content/uploads/2021/03/Attestation-for-return-to-school_03-05-2021.pdf) to return to us by scan or photography to info@campwaterdown.com either the night or morning before returning.

If you have any questions please contact us at info@campwaterdown.com or Shelley Bradaric, WDCC Executive Director directly at shelley.bradaric@campwaterdown.com.
Version: March 11, 2021

Note: Our form is only slightly different from the HWDSB/City of Hamilton Attestation PDF form (to expedite it's processing for your child's return).

YOU MUST ALSO NORMALLY PROVIDE A SEPARATE PAPER COPY of THEIR VERSION PDF FOR YOUR SCHOOL'S OFFICE: https://www.hwdsb.on.ca/wp-content/uploads/2021/03/Attestation-for-return-to-school-03-01-2021.pdf (we do not provide a copy of ours to the school).

Parent Name*

First Last

Telephone*

(Add extension only if necessary)

Email*

Child's Full Name*

Please enter the child's FULL name.

Program Location*

WDCC (215 Parkside Dr)
Allan A. Greenleaf (WDHS)
Mary Hopkins
Guy B. Brown

Program*

Toddler
Preschool
Kindergarten
Grades 1 - 8

Child's Group Name

(if known)

Date of Exclusion*

My child failed the Ontario COVID-19 school screening tool, WDCC's active screening or was sent home from child care / school on this date.

Date of Return*

My child has met the criteria selected below and would like to return to child care or before / after school program on this date.

It has been a minimum of 24 hours since my child was first excluded and they (or the affected household member) have a) had a negative COVID-19 test result, or b) been cleared by public health directly to return, or c) have been diagnosed with another condition by a medical professional.*

Yes
No

Please note that there are different exclusion periods and criteria for a diagnosed contagious condition other than COVID-19. Please contact us directly at info@campwaterdown.com to receive further instructions should your child have strep throat, pink eye, influenza, etc. More information can be found here: Infection Control Guidelines for Child Care

Please keep your child at home until 24 hours have passed and the child (and/or affected household member) has a) had a negative COVID-19 test result, or b) been cleared by public health to return, or c) is diagnosed with another illness by a medical professional. Symptoms must be improving and the child otherwise ready to return to school.

Choose Return Criteria*

Please select the box that applies best. You may add notes at the end. This form is reviewed by our administration and shared with your program screening staff to facilitate re-entry.

If your child was not ill, but was excluded because a sibling or household member had symptoms, then we have added a new option for that circumstance.

*Please add a note indicating if your child still has symptoms, or if suppressed by medications (i.e. Tylenol, antihistamines, etc.).

If the exclusion is due to another household member's symptoms and that household member does not receive a medical assessment or negative COVID-19 test, then the child must remain at home for a period of 14 days (and subsequently meet screening criteria).

My child had a negative COVID-19 test after starting to feel sick but is recovering (no fever, 24 hours, no travel, not close contact, not isolating)

My child had a negative COVID-19 test after starting to feel sick, and:

My child does not currently have a fever (without using medication);and
It has been at least a full day since my child began to feel better; and
My child has not travelled outside of Canada, OR 14 days have passed since the date of return; and
Has not been identified as a close contact of someone who is confirmed or suspected as having COVID-19 by Public Health or the COVID alert app on their own phone; and
Has not been directed by a health care provider or public health official to isolate

My child was not tested for COVID-19, but told in past they have a medical condition such as allergies or asthma

My child was not tested for COVID-19, but:

My child was previously seen by a physician or nurse practitioner and was told that they have a medical condition, such as allergies or asthma; and
The medical condition causes the symptoms my child has now; and
The symptoms are not worse or different than usual; and
My child has not travelled outside of Canada, OR 14 days have passed since the date of return; and
Has not been identified as a close contact of someone who is confirmed as having COVID-19 by Public Health or the COVID alert app on their own phone; and
Has not been directed by a health care provider or public health official to isolate.

My child was not tested for COVID-19, however they have been diagnosed (medical reason) other than COVID-19

My child was not tested for COVID-19, however:

My child was seen by a physician or nurse practitioner since becoming sick; and
The physician or nurse practitioner told us that my child's sickness is caused by a diagnosis (medical reason) other than COVID-19; and
It has been at least a full day since my child started to feel better; and
My child does not have a fever (without the use of fever-reducing meds); and
My child has not travelled outside of Canada, OR 14 days have passed since the date of return; and
Has not been identified as a close contact of someone who is confirmed as having COVID-19 by Public Health or the COVID alert app on their own phone; and
Has not been directed by a health care provider or public health official to isolate.

My child was not tested for COVID-19, it has been 10 days away

My child was not tested for COVID-19, but:

10 days have passed since the date when my child started to feel sick; and
My child does not currently have a fever (without using medication); and
It has been at least a full day since my child started to feel better;and
My child has not travelled outside of Canada, OR 14 days have passed since the date of return; and
Has not been identified as a close contact of someone who is confirmed as having Covid-19 by Public Health or the COVID alert app on their own phone; and
Has not been directed by a health care provider or public health official toisolate.

Return to School: household member identified as a close contact (whose test was negative)

Return to School: My child is a household member with a person who was identified as a close contact who then became ill (must meet all criteria):

The close contact’s COVID-19 test results are negative; and
My child passed the Ontario COVID-19 school screening tool today.

Return to School, household member was ill (Household member tested negative, alternatively diagnosed or it has been 14 days)

Return to School: My child is a household member with a person (including any sibling) who became ill but not identified as a close contact (must meet all criteria):

The household member’s COVID-19 test results are negative; OR
The household member has been diagnosed by a physician or nurse practitioner with an alternative diagnosis; OR
It has been 14 days since the date of exposure to the household member's isolation or quarantine; AND
My child passed the Ontario COVID-19 school screening tool today.

Return to School: household member travelled, 14 day and released by HPH

Return to School: My child is a household member of a person who was in mandatory quarantine following travel outside of Canada (must meet all criteria):

It has been at least 14 days since the date of exposure to the household member in mandatory quarantine; and
The household member has been released by Public Health from their mandatory quarantine; and
My child passed the Ontario COVID-19 school screening tool today.

Return to School: Positive COVID-19 test, been 10 days and released by HPH

Return to School: My child had a positive COVID-19 test (must meet all criteria):

It has been at least 10 days from my child’s symptom onset or positive COVID-19 test; and
My child has been directed by Public Health that it is safe to return to school or child care; and
It has been at least a full day since my child began to feel better; and
My child does not have a fever (without the use of fever-reducing meds); and
My child passed the Ontario COVID-19 school screening tool today.

Return to School: Close Contact of positive COVID-19 or not tested person (and it has been 14 days and released by HPH)

Return to School: My child was a close contact of someone who had COVID-19 or someone with COVID-19 symptoms who was not tested for COVID-19 (must meet all criteria):

It has been at least 14 days since the date of exposure to the positive case or symptomatic individual who was not tested for COVID-19; and
My child has been directed by Public Health that it is safe to return to school or child care; and
My child passed the Ontario COVID-19 school screening tool today.

Return to School: Following School Dismissal (released by HPH)

Return to School Following School Dismissal: My child was dismissed from school or child care and was told to self isolate until we heard from Hamilton Public Health Services (HPHS):

HPHS has released my child from isolation and told me that my child is not a close contact of a confirmed COVID-19 case; and
My child passed the Ontario COVID-19 school screening tool today.

Details*

Please add any details here that may aid our understanding of the conditions that led to exclusion and are now met for re-inclusion of your child. Or indicate the date that a negative COVID-19 test result was received.

Signature*

Name

This field is for validation purposes and should be left unchanged.

Attestation to Return After an Illness or Exclusion (March 10 2021)

Attestation for return to Before/After School or Child Care following illness, exclusion or self-isolation

Choose Return Criteria*

Programs

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