The Preschool at DUMC COVID Screening Form
Please fill out the information below before your child leaves for school each day.
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Date *
MM
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DD
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YYYY
Time *
Time
:
Child's name *
Last name of teacher *
Has your child had close contact with anyone with a confirmed case of COVID-19? *
Is your child or anyone in your immediate family awaiting the results of a COVID-19 test? *
Check any symptoms that your child has displayed that cannot be attributed to another health condition in the last 24 hours: *
Required
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