CCSC Covid-19 Student Symptom Screener
This form is to be filled out AFTER your return to school has been approved by building administration.
Student's First Name *
Student's Last Name *
Today's Date *
Ex. 02/01/2021 (MM/DD/YYYY)
MM
/
DD
/
YYYY
Student's School *
Has the student experienced any of these symptoms in the last 24 hours? *
Submit
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