Required Agreement for Diocese of Arlington Catholic School Students

Assumption of Risk

The novel coronavirus, COVID-19, has been declared a worldwide pandemic and is contagious. As a result, in order to resume in-person schooling, the Catholic Diocese of Arlington has established essential health and safety measures at the Catholic school named above ("School"). The School has put in place reasonable preventative measures and standards of behavior, consistent with guidelines issued by the Centers for Disease Control and Prevention (“CDC”) and state and local public health guidance, to reduce the spread of COVID-19 in School activities. Even with implementation of health and safety protocols, however, the Diocese and School cannot guarantee that you or your child(ren) will not become infected with COVID-19, and participation in School activities could increase your risk and/or your child(ren)'s risk of contracting COVID-19. Any interaction with others includes possible exposure to, and illness from, communicable diseases including COVID-19 and influenza.

I understand that my family has choices for completing schooling at home, or in another manner. By returning my child(ren) to in-person schooling, I give my informed consent for me or my child(ren) to participate and assume responsibility for the above-noted risks.

I willingly agree that my child(ren) and/or I will comply with the health and safety protocols established by the School, and will take all reasonable and necessary additional precautions to protect against communicable diseases while on School premises, not only for our own benefit but for the benefit of others with whom we may come into contact. We agree that, if we observe any objects, practices or procedures we believe to be hazardous while on School premises, we will remove ourselves from the location of such hazard and bring it to the attention of School administration immediately.

Liability Waiver

By signing this agreement, I acknowledge the contagious nature of COVID-19 and that my child(ren) and/or I may be exposed to or infected by COVID-19 by participating in in-person school activities, and that such exposure or infection may result in personal injury, illness, permanent disability, and/or death. I understand that the risk of becoming exposed to or infected by COVID-19 at the above-named School may result from the actions, omissions, or negligence of myself, my child(ren) or others, including, but not limited to Diocesan or School administrators, employees, volunteers, and other students/program participants and their families.

I further agree on behalf of myself and/or my child(ren) named herein, and our respective heirs, successors, and assigns, to fully and forever release, defend, indemnify, and hold harmless the Catholic Diocese of Arlington, the named School, their clergy, administrators, employees, agents, members and volunteers ("Indemnitees") from any and all claims, damages, demands, and causes of action, present or future, known or unknown, anticipated or unanticipated, in any way related to exposure to COVID-19 while participating in School activities, including but not limited to any claims of negligent exposure. This includes claims that arise from my own and others’ acts, actions, activities and/or omissions, excepting only those which arise solely from the gross negligence, recklessness or intentional torts of Indemnitees. I will defend and indemnify Indemnitees with respect to any released claim, including but not limited to damages, costs and attorney’s fees.

Responsibility for Health Screening

By execution of this Statement, I affirm that my or my child(ren)’s presence at School on any day constitutes an affirmative representation on my part that I/we have performed the required health screening below and affirm that the responses to all questions are NO.


“YES or NO, neither I nor my child(ren) have any of the following:”

• A fever of 100.4°F. (38°C.) or higher or a sense of having a fever during the past 72 hours

• New or unexpected cough that cannot be attributed to another health condition

• New shortness of breath or difficulty breathing that cannot be attributed to another health condition

• New chills that cannot be attributed to another health condition

• A new sore throat that cannot be attributed to another health condition

• New muscle aches that cannot be attributed to another health condition or specific activity (such as physical exercise)

• New loss of taste or smell

• Nausea, vomiting or diarrhea

• Currently living with a person who has exhibited symptoms of COVID-19 or is currently under quarantine due to close contact with a person suspected or confirmed to have COVID-19

“YES or NO, in the past 14 days, neither I nor my child(ren) have done any of the following:”

• Cared for or had other close contact with a person suspected or confirmed to have COVID-19

• Travelled internationally

I understand that on any day when anyone in our household answers YES to any of the required health screening questions above, I and/or my child(ren) are not permitted to participate in in-person School activities.

Need to Inform and Quarantine

I further understand, in the event that I/my child is suspected or confirmed positive with COVID-19 or has come in close contact with a person suspected or confirmed positive with COVID-19, I/my child will need to follow the CDC’s guidance for isolation or quarantine as appropriate. Information is available at I agree to inform the School administration as soon as possible, but no later than 1 business day, after learning of my/my child’s suspected or confirmed positive case of COVID-19 and/or the need to quarantine due to close contact with a person suspected or confirmed positive for COVID-19.

I understand that I/my child may not return to in-person School activities until approved by School Administration. Approval will be based on confirmation that the CDC's criteria to discontinue home isolation or quarantine has been met. For details reference:

For those suspected or confirmed positive:

For those quarantining due to close contact:

I hereby authorize the School to enforce such other reasonable measures and directives as may be deemed necessary by the Bishop of the Diocese of Arlington, its Office of Catholic Schools, or the School leadership. By execution of this Agreement, I understand and agree to the foregoing terms and conditions. ​
ex. 703-555-1111​​