Parent/Student Pre-Screen
Please complete the following.
Email address *
What is today's date? *
MM
/
DD
/
YYYY
Student's full name (1st child): *
Your temperature reading today is (1st child) *
Are you experiencing any one (1) of the following symptoms? *
Required
Are you experiencing any two (2) of the following symptoms? *
Required
Student's full name (2nd child if applicable):
Your temperature reading today is (2nd child if applicable)
Are you experiencing any one (1) of the following symptoms?
Are you experiencing any two (2) of the following symptoms?
Student's full name (3rd child if applicable):
Your temperature reading today is (3rd child if applicable)
Are you experiencing any one (1) of the following symptoms?
Are you experiencing any two (2) of the following symptoms?
Have you engaged in travel outside the state of PA? *
If you answered yes to travel outside of PA, please indicate which state you have traveled to.
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