Preschool Health Pledge - Lake Bluff Park District

The Lake Bluff Preschool is committed to the safety and health of our students, staff and all additional patrons. Please complete this pledge as this ONE time promise for the fall semester that you are committed to delivering your child to school healthy and ready for social interaction with others. (We will ask you to take this pledge again for the spring semester beginning January, 2022.) Violations of your pledge are highly discouraged and may affect your child’s enrollment in Lake Bluff Preschool. We take “staying in school” very seriously so please help us to be safe.

Fall Semester Pledge

Child's Name*
Is your child experiencing any symptoms related to COVID-19, i.e. fever, cough, sore throat, shortness of breath, chills, muscle pain, new or unusual headache, new loss of taste or smell, fatigue, congestion or runny nose, nausea or vomiting, or diarrhea?*
- Yes
- No
Has your child been in close contact * with someone who has been diagnosed with COVID-19 in the last 14 days?*
- Yes
- No
* Close contact includes household contacts, intimate contacts, or contacts within 6 feet for 15 minutes or longer.
Has your child tested positive for COVID-19 in the last 14 days?*
- Yes
- No
Consent*
By checking this box I accept the terms below.
By coming to the facility you acknowledge that you have in fact conducted this self-assessment and the information provided above is true and accurate to the best of your current knowledge and beliefs. You also agree to abide by the Lake Bluff Park Districts rules on social distancing, hand washing, and face covering during the time spent in their facility.