Health Screening Assessment
To reduce illness at LLL, we ask that you check on the health of your child daily and complete this form prior to arriving to the program.

Please
Student Name *
Email *
Below is a list of common COVID-19 symptoms. Is your child expressing any of those symptoms below? *
Required
My child has experienced any COVID-19 symptons in the past 14 days *
Required
My child has tested positive for COVID-19 in the past 14 days *
Required
My child has had close or proximate contact with confirmed or suspected COVID-19 case in the past 14 days *
Required
My child has traveled to any of the restricted high risk states listed here on https://coronavirus.health.ny.gov/covid-19-travel-advisory *
Required
Temperature at home
Submit
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