Covid -19 Weekly Mandatory Health Screening Questionnaire (21-22)

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Parents will complete the mandatory health questionnaire for each household. The health and safety of our students and staff is of paramount importance. This questionnaire will be utilized to track contact details and symptoms of everyone in the building, which will allow us to prevent the spread of COVID-19. Along with daily temperature and health screenings, all parents are required to complete this questionnaire. Pursuant to NJ Law, any student that is absent or sick will have to bring clearance from a doctor stating that the student is permitted to return to school.
We thank you in advance for your continued cooperation and support.

Email *

1. Parent’s First and Last Name *

In the past 14 days, have you or someone in your household, had close, unprotected contact with a suspected or known COVID-19 patient ? * *

Yes

Children's names and grades *

In the past 14 days, have you or anyone in your household traveled domestically or internationally? *

Yes

Within the past 10 days, have you or anyone in your household experienced a fever of 100.4 F , a new cough, new loss of taste or smell, or shortness of breath ? *

Yes

In the past 10 days, have you or anyone in your household tested positive for COVID-19? *

Yes

I hereby confirm that the information provided above is accurate, correct and complete. *

Yes

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