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St. Mary's Visitation 2021 Tball
Covid-19 Consent Form
*
Indicates required field
Name of Student(s)
*
Name of Parent/Legal Guardian
*
First
Last
Parish
*
Section 1: The COVID-19 Pandemic
The novel coronavirus, COVID-19 (hereinafter “COVID-19”), has been declared a worldwide pandemic and is extremely contagious. As a result, in order to resume in-person religious education at the above-referenced parish, collaborating parishes, or multi-parish community (hereinafter “Parish”), social distancing and other safety measures have been enacted at Parish. The Parish has put in place safety measures and standards of behavior to reduce the spread of COVID-19 while attending religious education classes. Even with implementation of safety protocols, Parish cannot guarantee that you, members of your household, or your child(ren) will not become infected with COVID-19 and cannot guarantee that attendance at religious education will not increase your risk and/or your child(ren)'s risk of contracting COVID-19.
Section 2: Direction to Parents and Legal Guardians
In addition to the safety measures being implemented by Parish, the above-named parents and/or legal guardians (hereinafter “Parents and Legal Guardians”) hereby agree to adopt the following safety measures of their own to help ensure the safety of all religious education students, families, teachers, and staff. Prior to attendance of child(ren) at religious education, Parents and Legal Guardians shall take the necessary steps to determine whether their child(ren) are exhibiting symptoms of COVID-19, including, but not limited to, temperature checks for fever (as defined by the CDC as at or above 100.4), review for the presence of any symptoms commonly associated with COVID-19, such as cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, headache, new loss of taste or smell, sore throat, congestion or runny nose, nausea or vomiting, and/or diarrhea. Should your child(ren) exhibit any symptoms of COVID-19, we require that you keep your child(ren) home.
Section 3. Students Exhibiting COVID-19 Symptoms at Religious Education
Should a child demonstrate any symptoms of COVID-19 while attending religious education, Parish will contact that child’s Parents and Legal Guardians to require that child be picked up from Parish and taken home in a timely manner.
Section 4. Known Exposure to COVID-19.
In the event that a child or a household member living with a child has been knowingly exposed to COVID19, the Parents and Legal Guardians of that child hereby agree to immediately take the following steps:
1. Contact child’s primary care physician
2. Notify the local health department.
3. Follow the local health department’s protocols for quarantine, isolation, and return to work or school.
4. Notify Parish of the exposure.
5. Prior to child returning to religious education, Parents and Legal Guardians agree to contact Parish to inform Parish of the steps taken to ensure that child is no longer contagious based on the protocols and guidelines of the local health department.
Section 5. Positive COVID-19 Test.
In the event that a child or a household member living with a child has tested positive for COVID-19, the Parents and Legal Guardians of that child hereby agree to immediately take the following steps:
1. Contact child’s primary care physician
2. Notify the local health department.
3. Follow the local health department’s protocols for quarantine, isolation, and return to work or school.
4. Notify Parish of the exposure.
5. Prior to child returning to religious education, Parents and Legal Guardians agree to contact Parish to inform Parish of the steps taken to ensure that child is no longer contagious based on the protocols and guidelines of the local health department.
6. Provide Parish with evidence of child’s negative COVID-19 test result and/or a release from child’s primary care physician.
Section 6. Acknowledgement of Risk
By signing this COVID-19 Pandemic - Student/Family Statement of Operations, Understanding, and Consent for Religious Education, I/we acknowledge the contagious nature of COVID-19, that my/our child(ren) and I/we may be exposed to or infected by COVID-19 by attending and/or working and/or volunteering at religious education, and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I/we understand that the risk of becoming exposed to or infected by COVID-19 at the above-named Parish may result from the actions, omissions, or negligence of myself/ourselves and others, including, but not limited to Parish employees, volunteers, students, and their families.
I/we further agree on behalf of myself/ourselves, my/our child (student) named herein, and my/our heirs, successors, and assigns, to absolutely release, defend, indemnify, and hold harmless the named Parish, teachers, volunteers, and the Archdiocese of Milwaukee, its directors, officers, employees, attorneys, agents, representatives, and insurers/third-party administrators(hereinafter collectively referred to as the "Indemnified Parties") from any and all claims or causes of actions in any way related to COVID-19, brought by any person or entity, including but not limited to, all claims and causes of action based on the alleged negligence of the Indemnified Parties, other third parties, or my own negligence.
I/We acknowledge that I/we have read the foregoing COVID-19 Pandemic - Student/Family Statement of Operations, Understanding, and Consent for Religious Education and that I/we understand and agree to its contents.
Legal Parent/Guardian Signature
*
Date
*
Legal Parent/Guardian Signature
*
Date
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By entering my full name, I attest that this constitutes my legal electronic signature on this form.
Continue to Payment
Home
Grow with Us
>
Our History
About Us
>
Parish Staff
Our Parish School
Our Ministries
>
For Kids
For Teens
For Adults
>
Visitation Speaker Series
Resources
Mass Schedule
Calendars
Weekly Bulletin
Contact Us
Update My Information
Pray with us
Mass Times
Perpetual Adoration
Sacraments
Devotions
Funerals
>
Funeral Readings
Funeral Music
St. Mary's Cemetery
Serve with Us
Parish Calendars
Liturgical Ministries
Music Ministry
Human Concerns
>
Respect Life
Prayer Request
Christian Women
Thrift Shop
Leadership
Stewardship
Support our Parish
Make a Donation
Mass Intentions
Our Parish School
About our school
>
What sets us apart
Photo gallery
Curriculum
Tours, Tuition and admissions
In the News
School Calendar
Our School Staff
For Parents
For Students
Support Our School
After School Care
Athletics