COVID-19 Screening Form - Students
Please self-certify your child daily by asking the following questions. If any answer is "yes", do NOT enter the building. This also includes any siblings.
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Student's First and Last Name *
Date *
MM
/
DD
/
YYYY
BACS Student Email *
Has your child been in close contact (within 6 ft for at least 15 min) with anyone diagnosed with COVID-19 in the last 14 days? *
Has you child been advised to stay home/quarantine by the Health Department or a Health Provider? *
Has your child or anyone in your household tested positive for COVID-19? *
Was you child tested for COVID-19 within the past 14 days and results are pending? *
Does your child have any of these symptoms? Check all that apply. *
Required
If you indicated above that your child has a fever, please submit their recorded temperature.
Has your child traveled internationally in the last 7 days? *
If your child has one or more symptoms, the child (and siblings, if any) should stay home, the sick child self-isolates, call a physician and get tested for COVID-19. Before returning to school, the parent must provide the child's negative COVID-19 test result and/or a doctor's note with diagnosis. The parent must speak with the school nurse before the child returns to school. Thank you!
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