Daily Screening Form
Parents and/or guardians must complete and submit this form each day, for each child, before the child(ren) reports to campus. If the answer to any of the following questions is YES, the child must stay home.

This screening form must be completed by 8:00 AM for each child, on each day they are scheduled to attend school for in person instruction.

By clicking the 'Submit' button at the end of these questions, I declare that the information I have provided is true.
Today's Date *
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DD
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Parent Name *
Phone *
Child's Last Name *
Child's First Name *
Child's Attending Building *
Screening Questions:
In the last 14 days, has anyone in your household had close contact with someone who has or is suspected to have COVID-19?

Has this child had a positive COVID-19 test within the past 14 days.

Has this child entered or reentered New York State from one of the restricted states within the past 14 days?

In the last 14 days, have you/your child(ren) experienced any of the following symptoms: Fever (over 100.0 °F) Headache, Cough, Sore throat, Shortness of breath, Chills, Muscle aches, Loss of taste and smell, Gastrointestinal (nausea, vomiting or diarrhea)
Please respond Yes or No in response to the above screening questions. *
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