Summer Covid Daily Health Screening Form
Date *
Student Name *
Self-Declaration By Student:
Have you had close contact with or cared for someone diagnosed with COVID-19 within the last 14 days? *
Have you experienced any cold or flu-like symptoms in the last 14 days (fever, cough, shortness of breath or other respiratory problem)? *
By printing your name below you verify that the above information is correct.
Parents Name *
Never submit passwords through Google Forms.
This form was created inside of Dar-ul-Islah. Report Abuse