Garden City Park STUDENT Health Questionnaire
Please complete this questionnaire each morning by 7:30am (not the evening before) if your child is attending In-Person Instruction.
If you have more than one child in the building, please complete it separately for each child.
*If your child rides a school bus and the form is not complete by 7:30am, the bus will not pick up your child that day.
If your child takes a school bus, please check YES
Child's LAST Name:
Child's FIRST Name:
Please select your child's teacher
Question 1: Check if your child has experienced one or more of these symptoms of Covid-19 in the past 14 days.
Fever (in excess of 100°F) or chills
Shortness of breath or difficulty breathing
Muscle or body aches
New loss of taste or smell
Congestion or runny nose
Nausea or vomiting
My child feels fine and has no symptoms listed above
If your answer to question 1, above, indicates that your child has experienced symptoms of COVID-19 and you believe they are not COVID-19 related, then you are encouraged, but not required to explain why here. Your response will be kept confidential to the extent required by law.
Question 2: Has your child been in close contact (within 6 feet) with a confirmed or suspected COVID-19 case in the past 14 days?
Question 3: Has your child had a positive COVID-19 test in the past 14 days?
Question 4: In the past 14 days, have you traveled to a state (excluding Pennsylvania, New Jersey, Connecticut, Massachusetts or Vermont) for 24 or more hours? If so, in order to enter the District’s buildings, you must provide the District with the dates of travel and a copy of the post-quarantine COVID-19 negative test result. The negative test result may be e-mailed to
Check one below:
I understand that, because I answered YES to any questions 1, 2, 3 or 4 above, I will NOT send my child to school today.
I answered NO to questions 1, 2, 3, and 4 above and I will be sending my child to school today.
By entering my name below I acknowledge that my answers to the questions above are true.
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This form was created inside of New Hyde Park-Garden City Park School District.