St. Peter Academy (Phase I: Summer 2020) Pre-Screen & Daily Check-In Form
Parents/Guardians are asked to fill out the following form for their family each morning before their child(ren) is/are by greeted by staff. This form may be filled out anytime after the child has woken up, and only after being thoroughly checked by their parent/guardian, each program morning.

As part of the check-in process, if any of the symptom questions below are answered with a "yes" by the child or guardian, the child will not be allowed to enter the building. In the case of a child, they must return home with a parent or caregiver. (Please note that the symptom of "fatigue" alone should not exclude a child from participation at St. Peter Academy.)
Last name of student(s) and/or faculty/staff *
First names of student(s) and/or faculty/staff *
Participant(s) in (Check all that apply): *
Today, or in the past 24 hours, have you or any of your household members had any of the following symptoms? *
Fever greater than 100 F?
Sore Throat?
Difficulty Breathing?
Gastrointestinal? (diarrhea, vomiting, nausea)
Unexplained Fatigue?
Unexplained Headache?
New loss of smell/taste?
New muscle aches?
Any other signs of illness?
Your email address *
I affirm that all of the information provided above relating to my child's health is true and correct to my knowledge. *
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