5th – 8th grade Return Pledge Return-to-School (5th-8th) Focusing on an in-person return to school in February, how many students do you have in grades 5th-8th grade?*Please enter a number from 1 to 3.Student Name (1)* First Last Class*5A - Semandiris5B - Schreck6A - Chiodo6B - Stroud7A - Ritscher7B - DeFeo8A - Secrest8B - MohrbacherCheck which best applies to student named above (you will be asked this question for each student):* We have reviewed the Family Pledge and will sign off on the Pledge below as part of my student's return for in-person learning on their grade's start date We have reviewed the Family Pledge and wish for this student to remain remote for the remainder of the school year We have read and will sign off on the Family Pledge and wish for this student to remain remote at this time, but may be interested in returning in the near future Student Name (2)* First Last Class*5A - Semandiris5B - Schreck6A - Chiodo6B - Stroud7A - Ritscher7B - DeFeo8A - Secrest8B - MohrbacherCheck which best applies to student named above (you will be asked this question for each student):* We have reviewed the Family Pledge and will sign off on the Pledge below as part of my student's return for in-person learning on their grade's start date We have reviewed the Family Pledge and wish for this student to remain remote for the remainder of the school year We have read and will sign off on the Family Pledge and wish for this student to remain remote at this time, but may be interested in returning in the near future Student Name (3)* First Last Class*5A - Semandiris5B - Schreck6A - Chiodo6B - Stroud7A - Ritscher7B - DeFeo8A - Secrest8B - MohrbacherCheck which best applies to student named above (you will be asked this question for each student):* We have reviewed the Family Pledge and will sign off on the Pledge below as part of my student's return for in-person learning on their grade's start date We have reviewed the reopening plan and wish for this student to remain remote for the remainder of the school year We have read and will sign off on the Family Pledge and wish for this student to remain remote at this time, but may be interested in returning in the near future Please confirm your household's commitment to the Family Pledge/Conduct to Return to In-Person Instruction: Conduct outside the home:* Avoiding non-essential close contact with people outside our household and not engaging in activities that are not COVID-safe. We understand that unsafe behaviors include but are not limited to (a) spending time indoors with non-household members; (b) spending time outdoors in close contact with non-household members without wearing a mask; and (c) not following social distancing protocols. Self-quarantining when applicable:* Keeping our child(ren) at home and reverting to remote instruction for 14 days (or the current local Public Health recommendations) if we travel outside the state, or if a member of our household engages in an unsafe behavior. Complete screening BEFORE sending to school:* Conducting daily health screenings and temperature checks PRIOR to sending our child(ren) to school and sending our child(ren) to school with a completed health attestation each day only if they pass. Complying with symptoms flowchart:* Not sending our child(ren) to school if he/she is exhibiting ANY potential COVID-19 symptoms (fever of 100.4 or higher, cough, loss of taste or smell, chills, shortness of breath or difficulty breathing, fatigue, headache, body aches, sore throat, congestion or runny nose, nausea or vomiting, diarrhea) and complying with all requirements on the King County Public Health Screening flow chart . Communicating with School Office regarding COVID-19 exposure, testing, COVID-19 symptoms:* Notifying the school office (office@holyrosaryws.org or covid@holyrosaryws.org) immediately if anyone in our household: - Tests positive for COVID-19 - Is experiencing any COVID-19 like symptoms and is being tested for COVID-19 - Was, within the last 14 days, exposed to or in close contact* with a person who has since tested positive for COVID-19, or someone who has been advised to quarantine or isolate. Cooperation on mask-wearing, social distancing, hand sanitization:* Speaking with our child(ren) about and promoting mask-wearing at all times while on campus and while in the presence of individuals outside our household, speaking with our child(ren) about following social distancing requirements, and reviewing proper hand-washing with our child(ren). Comments (Optional):Parent Completing Form: First Last Email of Parent Completing Form:*
