Sick Student Notification and Permission to Return to School/Child Care Forms

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The Fairfax County Health Department (FCHD), in collaboration with the American Academy of Pediatrics (AAP), has developed Sick Student Notification and Permission to Return to School/Child Care forms. These forms will continue to be required when a student is:

  • Sent home due to COVID Like Illness (CLI)
  • Reports a positive COVID-19 test
  • Is instructed to quarantine by a medical provider or the FCHD

This form is not required in cases when a parent / guardian has kept the student home from school with symptoms of CLI.

Sick Student Notification:

  • The Permission to Return to School/Child form must be completed prior to the student’s return to school.
  • This form will be completed by the School Public Health Nurse (PHN), School Health Aide (SHA), or FCPS staff member and is retained by the parent/guardian.

Permission to Return to School/Child Care Form:

  • This form will be completed by the child’s healthcare provider and returned to the school.
  • This form is to be filed in the student’s cumulative folder.
  • Copies of FCHD clearance letters (SARA alert forms) provided by the FCHD or a healthcare provider note will also be accepted. These documents should be stapled to the Return to School Form and placed in the student’s cumulative folder.

Additional acceptable documentation for student return to school following illness:

  • Copies of FCHD clearance letters (Sara alert forms) provided by the FCHD.
  • Healthcare provider note will also be accepted.
  • These documents should be stapled to the Return to School Form and placed in the student’s cumulative folder.

The forms and translations can be located on the following links:

SICK STUDENT NOTIFICATION and RETURN to SCHOOL FORM 

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