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Summer School Student Health Screener - City
School Name: CITY MIDDLE HIGH
Complete the screener below.
Haga clic aquí para leer en español:
https://grps.org/images/about_grps/pdfs/Student_Summer_Health_Screener_Spanishdocx.pdf
Kanda hano usome ibi muri Ikinyarwanda:
https://grps.org/images/about_grps/pdfs/Student_Summer_Health_Screener_KYdocx.pdf
Bonyeza hapa kusoma kwa Kiswahili:
https://grps.org/images/about_grps/pdfs/Student_Summer_Health_Screener_Swahilidocx.pdf
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* Indicates required question
Student Grade
*
Choose
PK
K
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5
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10
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1. Student's First Name
*
Your answer
2. Student's Last Name
*
Your answer
3. Has your child been placed in quarantine due to exposure to COVID-19 in the last 10 days?
*
Yes
No
4. Has anyone in your household tested positive for COVID-19 in the last 10 days?
*
Yes
No
5. Does your child have any of the following symptoms?
*
Yes
No
IMPORTANT NOTIFICATION: If you answered "YES" to any of the above questions, your child may not attend school or athletics/other activities today. Please contact your school for more information.
*
I have answered this screening tool honestly to the best of my knowledge.
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