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Student's First Name *
Student's Last Name *
Student's ID Number
Date of COVID-19 Test *
My student has not experienced or displayed any of the following COVID-19 symptoms in the last 24 hours and has not taken medication to control symptoms: ˚˚Cough ˚˚Sore Throat ˚˚Congestion ˚˚Runny nose ˚˚Fever/chills ˚˚Diarrhea ˚˚Loss of taste or smell ˚˚Shortness of breath or other respiratory symptoms ˚˚Muscle aches or severe fatigue ˚˚Nausea ˚˚Vomiting ˚˚GI symptoms ˚˚Headache
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Authorized Parent Signature (First and Last Name) *
I will direct my child to check in at the front office before attending school on their first day back *
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