Westerhold Early Learning Center

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School District 62 Student COVID-19 Self Certification Form

Formulario de Autocertificación COVID-19 para Estudiantes del Distrito Escolar 62

This form must be completed for *each* student, before they come to school.

Este formulario debe ser completado para * cada * estudiante, todos los días que venga a la escuela en persona.

Name of the family member submitting this form: (Nombre del miembro de la familia que someterá este formulario) *

Student First Name: (Nombre del estudiante) *

Student Last Name: (Apellido del estudiante) *

How will your student be arriving at school today? (¿Cómo llegará hoy su estudiante a la escuela?) *

Walking (Caminando)

District Transportation (Transporte del distrito- autobus, taxi)

Parent Drop off (Padre o guardián llevará al estudiante a la escuela)

Grade: (Grado) *

Classroom Teacher: (Maestro de salón) *

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