This form is reviewed by our administration and shared with your program screening staff.
NOTE: For school-age children there is a separate special paper form that you need to complete for your school (we do not forward a copy of ours to the school).
You must complete an attestation even if you have submitted one to the school.
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 fill out other fields.
Remember to add these children above after this child is added if applicable. (This field only shows names, you can't select a child.)
*Please add a note indicating if your child still has symptoms, or if taking medications (i.e. Tylenol, antihistamines, etc.).
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.