COVID Attestation Form-March
Monthly Attestation for COVID-19 Screening. By signing this form monthly you agree to perform the following symptom check daily on your student before they leave for school. If your student has ANY of the symptoms listed below they are to stay home and follow the District guidelines.
* Required
Student's Last Name:
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Your answer
Student's First Name:
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Your answer
School and Grade
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LMS 7th grade
LMS 8th grade
Please check EACH box to show that you have read and agree to check for these symptoms.
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A fever of 100.4 F or higher or a sense of having a fever
A cough
A sore throat
Shortness of breath or difficulty breathing
Chills
New loss of taste or smell
Nausea/vomiting/diarrhea
Congestion/runny nose- not related to season allergies
Unusual fatigue, muscle or body aches
Household members are not displaying signs or symptoms
There has been no contact with anyone with suspected or confirmed COVID-19
Required
Signature- by typing your name you are acknowledging that you have read and agree to check for the above symptoms. If your student has any of these symptoms keep them home and contact the school.
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Your answer
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