In_Person_Learning_Parent_Election_Form-_Fillable_Form.pdf

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Northwest Community Schools

In-Person Instruction Election Form (2020-2021 School Year)

Dear Parent/Legal Guardian:

The Northwest Community Schools Board of Education has adopted a COVID-19 Preparedness and

Response Plan (Plan) that offers you the opportunity to choose either in-person or remote instruction for the 2020-

2021 school year, to the extent permitted by Executive Order 2020-142 or any later Executive Order or local health

department order.

Please carefully review and sign this form if you wish to choose in-person instruction for your child(ren)

for the 2020-2021 school year. If you have any questions or require assistance in completing this form, please

contact the building office. Children whose parents/legal guardians do not submit this signed election form will be

assigned to remote instruction.

Parent/Legal Guardian Name [Print]:

Student Name(s) and Grade(s) [Print] Insert more lines or use another form, if needed.

Grade

I understand and agree that choosing in-person instruction for my child(ren) means:

A. Risk. Although the school has implemented increased health and safety protocols, the virus that causes COVID-

19 is novel and our understanding of the virus is incomplete and evolving. In making this choice, I have

considered the risks to my child(ren) of contracting or spreading COVID-19 and consulted with my child(ren)’s

health care provider or other advisors as I deemed necessary to make this decision.

B. Face Coverings. My child(ren) will wear a clean cloth face covering at all times during the school day except

during lunch time or as expressly permitted by school officials. Face coverings will be worn in hallways,

common areas, during arrival and dismissal, while waiting for or riding on a school bus, and in classrooms. The

cloth face covering may be of my choosing but must comply with the Code of Student Conduct (e.g., anti-

discrimination, anti-harassment) and U.S. Centers for Disease Control and Prevention (CDC) guidance (which

states that a face shield is not a face covering). Northwest Community Schools will supply each Face-to-face

student with a washable reusable mask. I will ensure or provide my child(ren) a clean cloth face covering each

day.

C. Screenings & Safety Protocols. My child(ren) will comply with, and I agree that school officials may take

reasonable steps to implement and require, COVID-19 mitigation measures including:

1. Wellness screenings

2. Temperature checks

3. Handwashing/sanitizing

4. Social distancing

5. Wiping student desks (upon request) between required custodial/janitorial cleanings

D. Violations. Failure to comply with COVID-19 mitigation measures, including face-covering requirements, may

result in my child(ren)’s reassignment from in-person to remote instruction.

E. Home Screenings and Stay-Home Symptoms.

1. I agree that each day, before sending my child(ren) to school, I will perform a home screening of my

child(ren) for symptoms of COVID-19 and if requested by the school, will complete and submit a school-

provided form documenting these screenings.