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LCMS Visitor Screening
IMPORTANT: If you or someone in your household are sick and/or have any of the symptoms below, please do not enter the school building but reschedule your appointment for a later time.
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Name: *
Phone Number *
Have you had a fever in last 72 hours? *
Required
Have you had a cough, difficulty breathing or shortness of breath related to illness in last 72 hours? *
Required
Have you taken any fever reducing medication (ie. Tylenol, Advil, or Motrin) in the last 72 hours? *
Required
Have you been in contact with anyone suspected of or tested positive for COVID-19 in last 14 days? *
Have you traveled outside of the Southern California region, defined as the counties of Imperial, Inyo, Los Angeles, Mono, Orange, Riverside, San Bernardino, San Diego, San Luis Obispo, Santa Barbara, and Ventura, in the past 10 days? *
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