COVID-19 School Health Screening Agreement
For the health and safety of our students, Oakland County Health Division (OCHD) requires students be screened for symptoms of COVID-19 before entering school. The Centers for Disease Control and Prevention (CDC) do not recommend screenings be done by the schools in consideration of time and interruption to education.

Please complete the information in the survey below prior to sending your child to school. By doing so, you indicate your understanding and agreement to perform daily symptom screenings on your child.

By completing this form, I am committing to screening my child daily for the 2020-2021 school year, unless otherwise directed. I also understand that it is my responsibility to call the school immediately if my child is not going to school for potential COVID-19 symptoms.
I commit to screening my child daily for COVID-19 symptoms and exposure.
Clear selection
Student Name (First, Last) *
Grade Level *
Parent(s)/Guardian(s) Name *
Last name, First name
Email Address *
Phone Number *
School Name *
Please indicate the school(s) your child(ren) attend.
Never submit passwords through Google Forms.
This form was created inside of Shared Email System. Report Abuse