COVID Health Screening Form 1
Child's Last Name *
Child's First Name *
Today's Date *
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Has your child been given any fever reducing medication in the last 72 hours? *
Has your child had a fever of 100.4 or higher within the last 72 hours? *
What is your child's current temperature? *
Has your child had any COVID symptoms such as a fever, dry cough, shortness of breath, or an unexplained rash in the last 72 hours? *
Has anyone in your home had any COVID symptoms such as a fever, dry cough, or shortness of breath in the last 72 hours? *
Has anyone in the family been exposed to someone who might have COVID? *
Does anyone at home have COVID? *
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