WOLCA Daily Screening
This form is to be filled out daily per WOLCA Family. No student will be allowed entry until this form is received.
Parent or Guardian's Name *
Please list your child(ren) attending school today.
I attest that my child or children listed above, are not experiencing any symptom of illness such as cough, shortness of breath or difficulty breathing, fever, chills, repeated shaking with chills, muscle pain, headache, sore throat, or new loss of taste or smell. *
I have not traveled internationally or a highly impacted area within the last 14 days *
I do not believe I or my family have been exposed to someone with a suspected and/or confirmed case of the Coronavirus/COVID-19. *
I am following all CDC recommended guidelines as much as possible and limiting my exposure to the Coronavirus/COVID-19. *
I or a member of my household have not been diagnosed with Coronavirus/Covid-19. If we have, we have been cleared as non contagious by state or local public health authorities. *
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