RBCS Health Screening Form/Formulario de Chequeo de Salud RBCS
Please complete the following health screening form if your child is sick or absent. Please complete a separate form for each student./Por favor complete el siguiente formulario de chequeo de salud si su hijo/a esta enfermo/a o ausente.
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Email *
Full Name of Student/Nombre Completo del Estudiante *
Grade/Grado *
Required
Temperature of Student before school/Temperatura del Estudiante antes de escuela *
Has the Student taken any medicine today? Please list type and dosage./¿Ha tomado algún medicamento el estudiante hoy? Por favor apunte el tipo y la dosis. *
Does the student have any of the following symptoms in the last 24 hours?/¿Ha tenido el estudiante los siguientes síntomas en las ultimas 24 horas? *
Required
Does the student have any of the following symptoms in the last 24 hours?/¿Ha tenido el estudiante cualquiera de los siguiente síntomas en las ultimas 24 horas?
Has the student had any of the following?/¿Ha tenido el estudiante cualquiera de lo siguiente? *
Required
Does the student have a Doctor appointment scheduled?/¿Tiene el estudiante una cita programada con el doctor?
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A copy of your responses will be emailed to the address you provided.
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