Student Health Screening One-time Attestation
Before entering our school buildings or buses, parents/guardians must complete a daily health screening for each child in their household. In addition, parents/guardians must sign and submit this form to the school district one time for each child. All questions must be answered and temperatures must be checked daily to confirm a body temperature lower than 100࿁F.

A parent or guardian is responsible for completing daily screening on behalf of their child(ren).
Below are the at-home screening questions that parents are required to answer daily for each child in the household.
If you have answered "NO" to all questions, your child may enter the school buildings and/or buses.
If you have answered "YES" to any question, your child will not be allowed to enter the school buildings.
Please contact the school nurse for further recommendations.
Student Name (Last, First) - ONE STUDENT PER FORM *
Grade *
Parent/Guardian Submitting Form (Last, First) *
By submitting this form, I agree that I will monitor my child for these symptoms each day and will not send my child to school if any of the above symptoms or conditions are present. *
Please complete one form for each student in your household.
OPTIONAL - Would you like to provide a copy of your child's COVID-19 vaccination card and/or proof of positive test to help with contact tracing?
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