Welcome to Brookfield Schools – Innovative, Practical and ...



A Trauma Sensitive Approach to Academic & Therapeutic Excellence

Building Access Affirmation/Waiver

All persons entering the building, including parents, staff, students, and visitors, must complete and sign this form prior to entry. Parents, staff, and students age 18 and older must sign for themselves. Students under the age of 18 must have a parent or guardian sign on their behalf.

Despite taking the necessary precautions to protect individuals entering our building, there is always a risk that someone may be exposed to or may contract COVID-19. As a result, anyone entering the building assumes the risk that he/she may be exposed to or contract COVID-19.

I, __________________________________________ (Print Name), attest and consent to the following on behalf of ______________________________ (Print Name):

● I agree to abide by all applicable rules and regulations governing Brookfield Schools.

● I have not traveled to any restricted states on the Governor’s Travel Advisory List within the past 14-days.



● Within the past 14 days, I have not participated in an event or activity that does not comply with the State of New Jersey’s guidelines on gatherings (e.g. indoor events with more than 25 persons in attendance, or outside events with more than 25 persons in attendance where a distance of 6 feet or more was not maintained between attendees).

● I have not tested positive for COVID-19 within the past 14 days and have not been exposed to anyone who has tested positive for COVID-19 within the past 14 days.

● I have taken my temperature today and it was below 100 degrees.

● I understand that, by entering the building, I acknowledge and assume the risk of being exposed to and/or contracting COVID-19.

● I hereby forever generally release, waive, discharge, indemnify, and covenant not to sue the Board or Brookfield Schools, and any of its members, directors, officers, employees, and agents, for any and all claims relating to any illness or injury that may result from entering the building.

Parent/Guardian or Student Signature: ________________________________________

Date: _____________________ (Must Be Same Date as Entry to Building)

-----------------------

Accredited by The National Commission for the Accreditation of Special Education Services

Dr. Patrick T. Kiernan., Executive Director/Superintendent



................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download