School of the Epiphany: Student Daily Health Form
Please complete this form every school day BEFORE bringing your child to the School of the Epiphany campus

Following San Francisco's Department of Public Health guidelines, if anyone in your household has been exposed to someone testing positive for COVID-19 and/or is taking quarantine precautions, please keep your child(ren) at home and contact the school at 415-337-4030 for further instructions.
Your Name *
Email address *
Last name of child(ren) *
1st Student Name *
Grade of 1st Child *
2nd Student Name (only fill out if you have a 2nd child attending school today)
Grade of 2nd Child
3rd Student Name (only fill out if you have a 3rd child attending school today)
Grade of 3rd Child
Temperature: Does your child(ren) have temperature 100.4ºF (38 ºC) or above? *
In the past 24 hours has your child(ren) had any of the following symptoms? *
Captionless Image
Required
Have you had close contact with or live in the same household with someone who had a test confirming they have COVID-19? *
Submit
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