Daily Academy COVID-19 Screening Questionnaire
First Name of Student *
Last Name of Student *
Class Level *
Please select the day of your child's class *
Please enter the time of your child's class *
Please provide your phone number. *
Does your child have any of the following symptoms: fever and/or chills, sore throat or difficulty swallowing, new or existing cough, barking cough, difficulty breathing, decrease or loss of taste or smell, runny or stuffy nose, headache, nausea, vomiting and/or diarrhea, extreme tiredness or muscle aches? *
Has your child travelled Internationally within the last 14 days (outside Canada)? *
Has your child had a close contact with a confirmed or probable case of COVID-19? *
Has your child had close contact with a person with acute respiratory illness who has been outside Canada in the last 14 days? *
Has a doctor, health care provider or public health unit advised that your child should be currently isolating (staying at home)? *
Please verify the following: *
Please enter your full name, acknowledging that you have read and agree to the above. *
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