St. Patrick School Health Check-In
Daily screening is required for entry to St. Patrick School for all Staff and Students.
Last name *
Student 1 *
Please check if you have any of these symptoms: *
Required
In the last week, has your child been exposed to a person with COVID symptoms or a positive test result, traveled or had a guest 150 miles outside your county, participated in unsanctioned or unregulated group activities or sports, and/or attended an outdoor event with more than 12 people or an indoor event with more than your family cohort? *
Student 2
Please check if you have any of these symptoms:
In the last week, has your child been exposed to a person with COVID symptoms or a positive test result, traveled or had a guest 150 miles outside your county, participated in unsanctioned or unregulated group activities or sports, and/or attended an outdoor event with more than 12 people or an indoor event with more than your family cohort?
Clear selection
Student 3
Please check if you have any of these symptoms:
In the last week, has your child been exposed to a person with COVID symptoms or a positive test result, traveled or had a guest 150 miles outside your county, participated in unsanctioned or unregulated group activities or sports, and/or attended an outdoor event with more than 12 people or an indoor event with more than your family cohort?
Clear selection
Submit
Never submit passwords through Google Forms.
This form was created inside of Catholic Schools Diocese of Oakland. Report Abuse