Weekly Health Screening Form
In an effort to reduce the risk of COVID-19exposure to all children and staff, all children attending school must complete the following screening questions before arriving for the first day of school.
Child's Name (please fill out a separate form for each child) *
Grade *
Parent's Name *
Has your child displayed any of the following symptons: fever, cough, sore throat, shortness of breath, nausea, vomiting, or diarrhea in the last 24 hours? *
Has your child been in contact with anyone who has been diagnosed with the coronavirus in the past 14 days? *
Has your child, or has anyone in your household, traveled internationally in the past 14 days, or have you or anyone in your household had contact with anyone who has traveled internationally in the past 14 days? *
Has your child, or anyone in your household, traveled to any of the states currently deemed to have high rates of COVID-19 in the past 14 days, or have you or anyone in your household had contact with anyone who has traveled to any of the high risk states in the past 14 days? *
Children answering YES to any of the above questions will not be able to attend school until they are quarantined 14 days or present a negative COVID-19 test to the office, I attest that I have answered all questions and my child can attend school. *
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