GSA Smiley Daily Student Health Screening
This form must be completed PRIOR to entering the school building each day, IN THE MORNING, that a student comes to school. Parents or Guardians should complete this form one time a day per child coming to school. Students who are exhibiting symptoms are NOT permitted to enter the building. If your child has any of the listed symptoms, they should not report to school until the parent or guardian speaks with the school nurse. Please call the school nurse at 314-932-7513 ext.3300 or email
Student Grade Level
Student First Name
Student Last Name
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This form was created inside of Gateway Science Academy of St. Louis.