Semester Symptom Screening

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

This form to replace the daily screening forms, teacherease survey and bus coupons. One form for each family will be on file for the semester. If students are showing any signs of illness they are to be kept home from school. Any student being kept home from school needs to be reported to the school office.

Last Name *

First Name *

School Building *

Sheridan

Harding

Serena Middle School

Serena High School

Multiple Buildings

Name of Students *

I will ensure that my student is sent to school healthy. If they are showing any sign of illness they will be kept home. If staying home, I will call the office to let them know that my child will be home sick and if any additional steps need to be taken. *

Yes

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Serena School District .

Does this form look suspicious? Report

Forms