Al Falah Academy 'October' Self Certification Screening
Al Falah Academy ("AFA") places the highest priority on the health and safety of our community. As the COVID-19 pandemic continues to evolve and spread globally, we have implemented this screening for those who are attending. Due to the high transmission levels in District 204 (Fischer Middle School's District), monthly self-certification is required. Self-certification requirements will change with district transmission levels.
Please complete this form for EACH student and/or staff member attending BEFORE Monday, October 2nd, 2021. If this form is not completed on time, a staff member will follow-up with you for completion. Unfortunately, students and staff will not be allowed into the building if they are not self-certified.
"Self-certification does not mean you are saying your child is symptom-free for an entire month, but rather that you will monitor your child's health closely every day and keep them home when they are not feeling well." (District 204)
Jazak Allahu Khair for your cooperation,
ICN Al-Falah Administrative & COVID-Response Teams
Sign in to Google
to save your progress.
Your Full Name
Your Phone Number
Your Email Address
Are you a Parent or a Staff Member?
If you are filling this off on behalf of a student, please choose "Parent" below. If you are a volunteer, filling this out for yourself, please choose "Teacher/Staff".
Page 1 of 4
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service