Chaparral Visitor Screening
Please complete one form for each visitor. IMPORTANT: If you or someone in your household are sick and/or have any of the symptoms below, please do not enter the school building but reschedule your appointment for a later time.
First Name *
Last Name *
Email address *
Phone Number *
Who do you have an appointment with?
Have you had a fever in the last 72 hours? *
Have you had a cough, difficulty breathing or shortness of breath related to illness in the last 72 hours? *
Have you taken any fever reducing medication (i.e. Tylenol, Advil or Motrin) in the last 72 hours? *
Have you been in contact with anyone suspected of or tested positive for COVID 19 in the last 14 days? *
For Health Office use only upon arrival - actual temperature taken:
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