Parent/Guardian Acknowledgement & Attestation Form 2020


  1. I acknowledge the contagious nature of the Coronavirus/COVID-19 and that the CDC and manyother public health authorities still recommend practicing social distancing and wearing face masks when distancing is not possible.
  2. I further acknowledge that SAU #70 schools have put in place preventative measures to reduce the spread of the Coronavirus/COVID-19 while students are in school buildings.
  3. I further acknowledge that SAU #70 cannot guarantee that my child will not become infected with the Coronavirus/Covid-19. I understand that the risk of my child becoming exposed to and/or infected by the Coronavirus/COVID-19 may result from the actions, omissions, or oversights of multiple entities and interactions, not only when attending in-person schooling.
  4. I acknowledge that I must comply with all procedures set forth by current CDC, New Hampshire Department of Health and Human Services, and Vermont Department of Health guidelines to help reduce the spread of coronavirus while my child attends school.


  1. I will keep my child home from school in the event they are experiencing any symptom of illness such as cough, shortness of breath or difficulty breathing, 100.4 or higher temperature, chills, repeated shaking with chills, muscle pain, headache, sore throat, or new loss of taste or smell, nausea, vomiting or diarrhea (also runny nose and nasal congestion in Vermont schools) that cannot be attributed to a known underlying health condition.

  2. No one in our household, including my child and live-in family, has traveled internationally or traveled on a cruise ship within the last 14 days.

  3. My child has not traveled outside of the New England states including: Maine, Vermont, New Hampshire, Massachusetts, Connecticut and Rhode Island (Students attending schools in New Hampshire including: Hanover High School, Frances C. Richmond Middle School or the Bernice A. Ray Elementary School) or to quarantine counties within states that are not allowed by Vermont guidelines (Students attending the Marion Cross Elementary School in Vermont) within the last 14 days.

  4. To the best of my knowledge, my child has not been exposed to, or in close contact with someone who has a suspected and/or confirmed case of the Coronavirus/COVID-19.

  5. No one in our household, including my child and live-in family, has been diagnosed with Coronavirus/Covid-19 and not yet cleared as non-contagious by state or local public health authorities.

  6. Everyone in our household, including my child and live-in family, is following all current CDC recommended guidelines as much as possible and limiting our exposure to the Coronavirus/COVID-19.

  7. I agree to conduct daily symptom screenings (listed above) prior to my child/children boarding a bus, car pool, or entering school buildings.

  8. I agree that my child will wear a mask as required while at school.

  9. I agree to promptly notify the school if my child is kept home due to the above-listed symptoms, any of the attestations are no longer true, or my child or a live-in family member either test positive for, or is diagnosed with, COVID-19.

Parent/Guardian Signature________________________________________
Parent/Guardian Print Name ______________________________________
Child (Children’s Names) __________________________________________
Date _________________________________________________________


SAU 70 – Dresden, Hanover, & Norwich School Districts