FAMILY Daily Entry Questionnaire
Complete this questionnaire DAILY via Google Forms between 6am-8am from home or while in park in the carpool line.

Have your submission confirmation/score page pulled up on your phone to show staff on carpool duty. If you don't have it available to show, staff are required to go through the questionnaire with you.

School Staff will still check student temps upon arrival.

Please note your submission will be timestamped for verification purposes.
Email address *
Family Last Name *
In the last 14 days, has anyone in your child's household(s) or have you been: ☐ Diagnosed with COVID-19? ☐ Awaiting COVID-19 Test Results? ☐ Tested positive for COVID-19 ☐ Recovered from COVID-19? *
25 points
In the last 14 days, has anyone in your child's household(s) or have you had a known exposure to a person with suspected/confirmed COVID-19? *
25 points
In the last 14 days, has anyone in your child's household(s) or have you had any of the following symptoms? ☐ Fever ≥ 100.4° F? ☐ Chills? ☐ Shortness of breath/difficulty breathing? ☐ Cough? ☐ Muscle pain/Body aches? ☐ Diarrhea? ☐ New loss of taste or smell? ☐ Sore throat? ☐ Congestion or runny nose? ☐ Nausea or vomiting? *
25 points
In the last 14 days, has anyone in your child's household(s) or have you traveled to a publicly attended event (particularly by air or to hotels) or attended a "highest risk" large or public gathering locally? *
25 points
Please explain any "YES" answers
If you answered YES to ANY of the test questions, you need to STOP and wait for administration before entering the building.
If you answered YES, do not enter the building. Follow our Absence/Illness protocols: http://bit.ly/illness-absence-protocols
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