COVID Parent Acknowledgement.

Heritage Academy requires that this document be signed by the family and placed in the scholar’s file. Please fill out the form below and submit by August 31st.

Please make sure you have read through our MITIGATION PLAN, FACE COVERING POLICY, DISTANCE LEARNING PLAN and list of COVID symptoms prior to signing the acknowledgement form below.prior to signing the acknowledgement form below.

  • Example: Smith, Robert
  • I have received a copy of the Heritage Academy Mitigation Plan, Distance Learning Plan, and Facial Coverings Policy and acknowledge that I am responsible for abiding by the practices outlined in these documents. I also understand that these documents may be available online. If I have any questions or concerns, I will speak with the school Assistant Principal to resolve them.
  • I understand that Heritage Academy assumes no responsibility for illness or injuries which I or my family members sustain as a result of my physical condition or resulting from my participation in any school activities.
  • I agree to screen my scholar(s) before coming to school for any of the following items: *fever of 100.4 degrees or higher, *chills; *shortness of breath *difficulty breathing; *muscle aches; *sore throat; *headache; *fatigue; *congestion *runny nose; *cough; *vomiting; *diarrhea; *new loss of taste or smell.
  • If these conditions are present, I will not bring my scholar to school and will notify the school.
  • I understand that in every class, my scholar will be asked the following questions:
  • 1. Are you feeling sick or feel any of the COVID symptoms? (see above)
  • 2. Have you been in close contact with a confirmed case of COVID-19?
  • 3. Are you experiencing a cough, shortness of breath, or sore throat?
  • 4. Have you had a fever in the last 48 hours?
  • I understand children will be required to wash hands after every activity and upon arrival and departure for their safety. (Where necessary and age appropriate hand sanitizer may be used.)
  • I understand that the school is not responsible for personal property lost or stolen while members and/or program participants are using Heritage facilities or participation in Heritage programs.
  • Signed:
  • MM slash DD slash YYYY