Student Medical Survey
Used for ministry and liability purposes for VBC
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Email *
09/22/2020 *
1. Has your family (within the last 14-21 days) come in contact with a confirmed COVID-19 patient? Y/N *
2. Has your child been fever free for at least 36 hours? Y/N *
3. Has your child suffered from a cough or respiratory infection? Y/N *
4. Has your child or anyone in your family had flu like symptoms, shortness of breath, headache, fever, or fatigue? *
Studen Name: *
Parent Name *
Child's grade level
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