COVID-19 Daily Health Status Check
This form is to be completed on the same day that your child is attending school before your child arrives at school.
Last Name *
First Name *
Child 1 Name *
Child 2 Name
Today's Date *
Today or in the past 24 hours, have you, any household members, or caregivers had any of the following COVID-19 symptoms? Check all that apply *
Are any of the following statements true? Check all that apply. *
My child normally attends school today, but they are staying home for a non-COVID 19 illness.
If you answered yes to the above question, please describe the symptoms below.
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