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.
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First and Last Name *
Child 1 Name *
Child 2 Name
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 related illness.
If you answered yes to the above question, please describe the symptoms below.
The following person is dropping my child off at school today *
I attest that the person dropping my child off at school today is fully vaccinated and has been fully vaccinated for over two weeks. If the answer is no, the child may be dropped off at the front door of school. *
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