Elm City - Wilson County Schools 2020-2021 K-12 Symptom Screening Parent / Guardian Attestation
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Child's First Name *
Child's Last Name *
Parent/Guardian First Name *
Parent/Guardian Last Name *
Has your child had close contact (within 6 feet for at least 15 minutes) in the last 14 days with someone diagnosed with COVID-19, or has any health department or health care provider been in contact with you and advised you to quarantine? *
Does your child have ANY of the following symptoms? If your child has ANY of these symptoms, he or she should stay away from other people, and you should call your child’s health care provider. *
Has your child been diagnosed with COVID-19? If your child is diagnosed with COVID-19 based on a test, their symptoms, or does not get a COVID-19 test but has had symptoms, they should not be at school and should stay at home until they meet the criteria below. *
Please type your full name in agreeance of the attestation form. *
Please enter today's date. *
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