Prentice School - COVID-19 Daily Health Certification
Email address *
Student's First Name *
Student's Last Name *
Grade Level *
Parent Name *
In the last 24 hours, has your child experienced: *
Yes
No
Fever of 100.4 F (38 C) or higher
Chills
Muscle aches
Cough
New loss of taste or smell
Sore throat
Shortness of breath
Uncharacteristic throbbing headache
Fatigue
Congestion
Runny nose
Nausea
Vomiting
Diarrhea
Has your child recently been in household contact with anyone who has exhibited any of these symptoms? *
Required
Has your child recently been in contact with anyone who is under investigation or has tested positive for COVID-19? *
Required
I affirm that my answers are true for answers listed above. *
Required
CCPA Notification
This information will be retained by authorized personnel only and treated as confidential medical information. This information is being collected in compliance with the California Consumer Privacy Act (CCPA). The categories of personal information being collected is medical and health information. The purpose is to identify potential symptoms linked to COVID-19 and reduce the risk of spreading the disease in or through the school.
A copy of your responses will be emailed to the address you provided.
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