Merrick Library Health Questionnaire
This form is to be filled out before a child enters the library garden for a program. If the answer to any of these questions is yes, the child may not attend the program.
What is your child's name? *
Has your child tested positive for Covid-19 in the last 14 days? *
Have your child had close contact or been near someone diagnosed with Covid-19 in the last 14 days? *
In the past 24 hours, have your child experienced any cold or flu-like symptoms, including fever, headache, cough, sore throat, shortness of breath, difficulty breathing, chills, muscle or body aches, nausea, vomiting, diarrhea, loss of taste or smell? *
What is your child's name? *
Has your child tested positive for Covid-19 in the last 14 days? *
Have your child had close contact or been near someone diagnosed with Covid-19 in the last 14 days? *
In the past 24 hours, have your child experienced any cold or flu-like symptoms, including fever, headache, cough, sore throat, shortness of breath, difficulty breathing, chills, muscle or body aches, nausea, vomiting, diarrhea, loss of taste or smell? *
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