Attestation to Return After an Illness or Exclusion (September 23 2021)

It has been a minimum of 24 hours (48 hours for gastrointestinal symptoms such as nausea, vomiting and/or diarrhea) since my child was first excluded*

AND they (or the affected household member) do not have new or worsening symptoms, AND have

been assessed and diagnosed with another illness by a medical professional and cleared to return, AND/OR
had a negative COVID-19 test result, OR
have been isolating for 10 or 14 days and are symptom free, OR
been cleared by Hamilton Public Health directly to return.

Yes
No

Symptomatic children may return if their symptoms are improved enough to participate FULLY in our program and do not have a fever (without the use of fever-reducing medications).

A child may not return to our program or school who was ill since their last attendance and has since recovered unless they have received a medical assessment and/or a COVID-19 laboratory test result in the interim or the child has isolated for 10 days.

[There are different exclusion periods for a diagnosed contagious condition other than COVID-19, and this attestation is not applicable. 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]

INSTRUCTIONS: Please keep your child at home until 24 hours have passed (48 hours for any gastrointestinal symptoms such as nausea, vomiting and/or diarrhea) and the child (and/or affected household member) has no new or worsening symptoms and a) been assessed and diagnosed with another illness by a medical professional, or b) had a negative COVID-19 test result, c) been cleared by public health to return, or d) has been isolating for 10 / 14 days and is now symptom free.

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

Your attestation must be truthful and complete. You are attesting that it is safe and approved for your child to return to our program.

For school-age children: there is a separate form than what will be required by your school (we do not provide a copy of ours to the school). You must complete this attestation even if you have already submitted one to your school.

If you have any questions please contact us at info@campwaterdown.com

Version: September 27, 2021

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*

Child's Group Name

(if known)

Date of Exclusion*

My child became ill, failed the Ontario COVID-19 school screening tool, WDCC/Camp Waterdown's screening or was sent home from child care / school / holiday care program on this date.

Date of Return*

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

Return Criteria

Please select all boxes that apply. For COVID test results and medical diagnoses we do require the date and results to be detailed in the notes field below. (We do not need to see or receive test results, nor a doctor's note UNLESS the child is diagnosed with a chronic non-infectious condition that is likely to trigger exclusion repeatedly on that basis.)

This form is reviewed by our administration and shared with your program screening staff.

*Please add a note indicating if your child still has symptoms, or if taking 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 10 days (and subsequently meet screening criteria).

If you have any question about what to select, or the selections do not seem to apply, please do not hesitate to reach out to us at the emails above.

Please check all the boxes that apply:*

Please check all the boxes that apply:
(at least one box must be selected)

My child (or household member) was assessed by a medical professional and has received an alternative diagnosis (please detail below)
My child (or household member) has received a negative COVID-19 laboratory-performed test result from the province (please provide the result and date received below)
My child has been told they can return to school / child care by their health care provider and/or Hamilton Public Health Services (HPHS)
My child received a letter dismissing their cohort from school and it has been at least 10 days since the date of last exposure to the positive case
It has been at least 10 days since the date of exposure to a positive COVID-19 case outside of school or to a symptomatic individual who was not tested for COVID-19
My child has completed their 14-day quarantine period since traveling internationally

AND

(Required)*

My child has passed the COVID-19 Ontario School and Childcare Screening today.

Ontario COVID-19 School and Child Care Online Screening (opens in a new window)

Medical Professional's Diagnosis or HPHS Release*

Please detail the diagnosis/release and/or the date of release.

Date of Negative COVID-19 test result*

(Laboratory test, Rapid Antigen Tests are not allowed for this purpose.)

Optional Details

Add details here that will aid our understanding of the conditions that led to exclusion that are now met for re-inclusion of your child.

Signature*

Thank you!

Our staff may contact you to make clarifications for our records.

You will receive a Notification from us after your attestation has been reviewed, confirming you are permitted to return. In some cases there may not be time to do so before you return for your screening check, so our staff may need to re-confirm that your attestation has been received and reviewed upon entry to the program.

Be aware that children recovering from illness (regardless of diagnosis or a negative COVID test) have returned only for symptoms to worsen or to show unexpectedly and we would need to re-exclude your child on that basis.

Email

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

Attestation to Return After an Illness or Exclusion (September 23 2021)

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

Return Criteria

Thank you!

Programs

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