COVID-19 Parental Acknowledge and Disclosure
1. While present at the center each day, I understand that my child will be in contact
with children and staff who are also at risk of community exposure. No list of
restrictions, guidelines, or practices will remove the risk of exposure to COVID-19.
2. I understand that the members of my family play a crucial role in keeping everyone at
the center safe and reducing the risk of exposure by following the practices outlined
in this acknowledgement.
3. I understand that during this COVID-19 public health emergency, I will not be
permitted to enter the center and that Lallipop Daycare staff will conduct pick up and
drop off outside the main door each day.
4. I understand that upon arrival each day my child’s temperature will be checked and
could be checked throughout the day. Children’s hands will be wash throughout the
day per CDC recommendations.
5. I understand that if there is an emergency requiring me to enter the center, I must
sanitize my hands and wear a mask before entering. While in the building I will
practice social distancing and remain 6 feet from all other people, except for my
children or immediate family members.
6. For my child to attend Lallipop Daycare, I understand that my child and all other
family members in my household must be free from COVID-19 symptoms. If any of
the following symptoms appear while at Lallipop Daycare, my child will be separated
from the rest of the class and moved to a supervised, secure area until I am able to
pick up. My child must be picked up within a reasonable amount of time (30-60
a. Symptoms include.
i. Fever of 100.4 or higher
iii. Shortness of breath
v. Muscle or body aches
vii. New loss of taste or smell
viii. Sore throat
ix. Congestion or runny nose
x. Vomiting or diarrhea
7. While Lallipop Daycare understands that many of these symptoms can also be due to
non-COVID-19 related issues, we must proceed with an abundance of caution during
this public health emergency. Symptoms typically appear 2-7 days after being
infected. If my child has had any symptom consistent with COVID-19, I understand
he/she should not return until:
a. Child is fever free for at least 24 hours without medication.
b. Other symptoms have completely resolved.8. I understand that if any other members of my family present with COVID-19
symptoms my child(ren) will need to remain at home until everyone is symptom free.
If a sibling or parent has symptoms all children in the household need to remain at
9. I agree to notify Lallipop Daycare management if I become aware that my child has
had close contact with any individual who has been diagnosed with COVID-19. The
CDC defines “close contact” as being within 6 feet of any infected person for at least
15 minutes or more starting from 2 days before illness onset (or, for asymptomatic
patients, 2 days prior to specimen collection until the time the patient is isolated.
10. Upon the exposure or close contact, my child(ren) and all family will have to
quarantine for a minimum of 14 days and a negative test or doctors note must be
obtained to return to Lallipop Daycare. If a negative test or doctors note is not
obtained my child(ren) will have to remain quarantined for a total of 24 days before
returning to the center. This is the recommendation provided to us by the local Health
In the event of a Positive COVID-19 test
11. All families will be notified immediately of any positive test result.
12. Based on each individual case, Lallipop Daycare will follow the recommendations of
the CDC and the local Health Department and communicate with parents throughout
13. Positive staff and children will be excluded from care for a minimum of 14 days and
will not be allowed to return until the 14 days has passed, and a negative COVID-19
test or doctors note has been obtained. If no test or doctors note is obtained staff or
children will not be permitted to return until 24 days after exposure.
I, ____________________________________________, certify that I have read, understand, and agree
to comply with the provisions listed herein.
Child’s Name(s): _________________________________________ DOB: ________________
Parent/Guardian Name: __________________________________________________________
Parent/Guardian Signature: ___________________________________________ Date: ______