FCCC Daily Health Screening Questionaire
This ONLINE form should be completed the SAME DAY prior to arriving at FCCC. A staff member will review your submission prior to your child's admittance into the building.  

These questions are asked of the parent/guardian who drops off their child to our facility and to the teachers/staff of FCCC.  It is used to determine the health condition of the person entering the facility who could potentially transmit the COVID-19 virus to other people within FCCC.  The information given will remain confidential and this form will be reviewed only by the Director and Pastors.  Teachers and children whose parents have 2 or more of the listed symptoms or have been in contact with anyone experiencing symptoms of COVID-19 in the past 14 days will not be allowed to attend classes.
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Name (First & Last) *
Have you traveled outside of States in the past 14 days? *
Have you tested positive for COVID-19 in the past 14 days? *
Have you had close contact with someone who has tested positive for COVID-19 in the past 14 days without wearing appropriate Personal Protective Equipment? *
Have you experienced any of the following symptoms in the past 14 days?
Please answer all of these health screening questions.
Fever (100.4° or greater)? *
New or worsening cough? *
Unexplained muscle soreness? *
Difficulty breathing? *
Sore throat? *
Decrease or loss of taste or smell? *
Chills? *
Vomiting, diarrhea or abdominal pain? *
Runny nose, or nasal congestion without other know cause? *
Parent / Guardian Signature (Type Your Name) *
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