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Conn-Area Catholic School

COVID-19 Parental Acknowledgment 2021-2022

I acknowledge and agree to the following means of safeguarding the School community in the midst of the COVID-19 global pandemic. 

  1. The novel coronavirus, COVID-19, has been declared a worldwide pandemic and is extremely contagious. The School has put in place reasonable preventative measures and standards of behavior in which members of the School community are expected to comply to reduce the spread of COVID-19 at School. Such precautions include, but are not limited to, handwashing/sanitizing, social distancing, and self-screening.  Even with implementation of these safety protocols, the School cannot guarantee that you/your child/a household member will not become infected with COVID-19 and attendance at School and/or participation in the School activity, sport, or event could increase you/your child/a household member's risk of contracting COVID-19.
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  2. Prior to each School day, activity, sport, or event, I acknowledge and agree that I must ask myself the questions below. Should the answer to any of the questions on any given day be "Yes," I understand my child is not permitted to attend School and/or participate in the School activity, sport, or event.
    • Has my child had a fever as defined by the CDC during the past 24 hours?
    • Has my child had a new or unexpected cough during the past 7 days?
    • Has my child been around anyone exhibiting these symptoms within the past 14 days?
    • Is my child living with anyone who has been sick, has exhibited symptoms of COVID- 19, or is currently under quarantine for exposure to COVID-19?
    • Is my child exhibiting any sign of infectious disease?
       
  3. I understand that, in the event my child develops symptoms or suspected symptoms of COVID-19 or other illness, or if otherwise requested by the Principal, at his/her discretion, I will be contacted by School, and I will make immediate preparations to have my child picked up from School.
     
  4. I further understand that, in the event that my child contracts COVID-19 or becomes exposed to someone with COVID-19, my child will need to be quarantined (as directed by Department of Health).
     
  5. I understand that my child cannot be present on School property or attend a School activity, sport, or event until he/she meets Pennsylvania Department of Health and Pennsylvania Department of Education's criteria to return to School (See https://www.dioceseofgreensburg.org/Pages/covid-acknowledgement.aspx).
     
  6. I understand that individuals who have a weakened immune system (immunocompromised) due to a health condition or medication may need to take additional precautions. These individuals are encouraged to consult their healthcare provider and work with the School Principal to effectuate any necessary reasonable accommodations.

To preserve the integrity of the School program throughout the pandemic, I further acknowledge and agree to the following:

A.  Will make every effort to provide remote learning available during any quarantine period throughout the pandemic, enabling students to continue their education seamlessly in and out of the classroom setting. Such distance learning shall be consistent with School's mission, providing faith formation, academic rigor, quality, academic support, and assessment of objectives consistent with in-person classes, and is subject to the Student Parent Handbook and School internet use policy.

B.  I understand that in-person School classes may be recorded and/or live streamed to facilitate distance learning, and I hereby give permission to record and/or live stream my child in the classroom setting for such educational purposes. The teacher shall have the sole ability to make such recordings, which shall be used strictly for educational purposes by the School community on approved platforms. Screenshots of individuals are strictly prohibited.

C.  I understand and agree that in the event it becomes necessary for School to solely educate students via distance learning for any time period, I will not be entitled to a refund of or release from payment for any tuition or fees.

D.  I give permission for my child to participate in any distance learning offered online by the School through educational platforms such as Zoom or Schoology platforms for online synchronous video instruction. I understand that web-based activities entail known and unanticipated risks that cannot be eliminated. As a result, School recommends the use of appropriate Internet filtering software.

I understand and voluntarily assume the risk of my child contracting COVID-19 by attending School and/or through participating in a School activity, sport, or event and hereby waive any and all claims against and agree to hold the School, Parish/Region, and Diocese of Greensburg harmless .

In consideration for providing my child the opportunity to attend School and/or participate in a School activity, sport, or event and any related transportation to and from the same, I agree to release, exonerate, discharge and hold harmless the School, its Governing Bodies, the individual members thereof, the Diocese of Greensburg, the Most Reverend Larry J. Kulick, Trustee, and all successors, assigns, officers, agents, employees. volunteers, and representatives from all liability, claims, causes of action, or demands, including attorney fees, fines, fees, or other costs (e.g. medical costs) arising out of any exposure to or illness or injury from an infectious disease including COVID-19, which may result from or in connection with my child's attendance at School and/or participation in a School activity, sport, or event and any related transportation to and from the same.

I/We am/are the parent or legal guardian of the student named above. I/We have carefully read and fully understand all provisions of this COVID-19 Parental Acknowledgement (and Assumption of Risk) and consent to the forgoing terms and conditions on behalf of myself/ourselves and the above-named student(s).

I Agree

First Parent/Guardian's Name

First Name*

Middle Name

Last Name*

Phone*
First Parent/Guardian's Age Acknowledgment*
First Parent/Guardian's Date of Birth*
I certify that I am 18 years of age or older
First Parent/Guardian's Signature*
Second Parent/Guardian's Name

First Name*

Middle Name

Last Name*
Second Parent/Guardian's Date of Birth*
Third Parent/Guardian's Name

First Name*

Middle Name

Last Name*
Third Parent/Guardian's Date of Birth*
Fourth Parent/Guardian's Name

First Name*

Middle Name

Last Name*
Fourth Parent/Guardian's Date of Birth*
Fifth Parent/Guardian's Name

First Name*

Middle Name

Last Name*
Fifth Parent/Guardian's Date of Birth*
Sixth Parent/Guardian's Name

First Name*

Middle Name

Last Name*
Sixth Parent/Guardian's Date of Birth*
Seventh Parent/Guardian's Name

First Name*

Middle Name

Last Name*
Seventh Parent/Guardian's Date of Birth*
Eighth Parent/Guardian's Name

First Name*

Middle Name

Last Name*
Eighth Parent/Guardian's Date of Birth*
Ninth Parent/Guardian's Name

First Name*

Middle Name

Last Name*
Ninth Parent/Guardian's Date of Birth*
Tenth Parent/Guardian's Name

First Name*

Middle Name

Last Name*
Tenth Parent/Guardian's Date of Birth*
Parent or Guardian's Email Address

Email
A signed copy of this waiver will be sent to the email address you provide.
Student Name(s)

Student #1 *

Student #2

Student #3

Student #4
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the parent or court-appointed legal guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*

Phone*
Parent or Guardian's Age Acknowledgment*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it.


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