Daily Screening Checklist
Please fill out this questionnaire every day your child comes to school at Majestic Harbor prior to entering the building. Children with a YES answer to any question will not be allowed to enter. Discovery of any untruthful answers may prevent future attendance to Majestic Harbor.
* Required
Email
*
Your email
Today's date
*
MM
/
DD
/
YYYY
Child's name
*
Your answer
Caregiver name
*
Your answer
Today or in the past 24 hours, have you or any household member had any of the following?
*
Fever (temperature 100.0 F or above), felt feverish or had chills?
Cough?
Gastrointestinal symptoms (diarrhea, nausea, vomiting)?
Headache?
New loss of smell/taste
New muscle aches?
NONE
In the past 14 days, have you had close contact with a person known to be infected with the novel coronavirus (COVID-19)? Close contact is defined as being within 6 feet of an individual who has tested positive for COVID-19 for more than 10 minutes while that person was symptomatic, starting 48 hours before their symptoms began until their isolation period ends?
*
Yes
No
I certify that my responses to the above checklist are accurate and truthful.
*
By checking this box you certify your responses are truthful.
Required
Do you authorize your child to use hand sanitizer with at least 60% alcohol diluted with water under staff supervision?
*
Yes
No
Pick-up time
*
Your answer
Send me a copy of my responses.
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