COVID-19 SELF MONITORING CHECKLIST

Please ask yourself and your children these questions before filling out the form.
Does your child have any of these SYMPTOMS OF INFECTION
Fever of 100.4 or higher, Cough, Headache, Sore Throat, Shortness of Breath, Fatigue, Loss of taste or smell
Unexplained body aches. Had contact with anyone who has been diagnosed with
or who may have symptoms associated with COVID-19?
If you answered YES to any of the above, then it is not safe to attend school. Please stay at home.
Email address *
Family Name
Name of child
What is your child's temperature?
Name of second child
What is your child's temperature?
Name of third child
What is your child's temperature?
Name of fourth child.
What is your child's temperature?
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