Sharon Community Education Daily COVID-19 Health Screening
Complete this form each day that your child will attend a Community Education program. You may complete the form up to 12 hours prior to their attendance but not earlier. The form is timestamped. Students will not be able to attend a Community Education program without this daily form completed and verified by staff.

Fill out one form per day per child.
First Name *
Last Name *
What school does your child attend? *
Child's grade. *
In the past 24 hours have you or any household members exhibited any of the following symptoms? *
In the past 14 days have you had close contact with a person known to be infected with COVID-19? *
I attest that I have been truthful in answering these questions and that to my knowledge no member of my household has had contact with COVID-19 or has COVID-19 symptoms, nor has my child been given medicine to lower a fever. I understand that should my child have exhibit any symptoms, I will not send my child to a Community Education program without symptoms abating, (fever free with out medicinal aid for 72 hours), my child being cleared by testing, or clearance from their health care provider. *
Parent/Guardian *
Never submit passwords through Google Forms.
This form was created inside of Sharon Public Schools. Report Abuse