Student COVID-19 Self-Assessment
This form must be complete prior to returning to campus every morning. One form per child.

Email address *
First & Last Name *
What grade are you in? *
Have you been within 6 feet of a person with a lab-confirmed case of COVID-19 for at least 5 minutes, or had direct contact with their mucus or saliva, in the past 14 days? *
In the last 48 hours, have you had any of the following NEW symptoms? Check all that apply. *
Has a public health official advised you to get tested for COVID-19? *
If you are feeling ill it is your responsibility to report it to the administration. By doing so, you are keeping our community safe. *
A copy of your responses will be emailed to the address you provided.
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