COVID-19 Student Symptoms Questionnaire
Please submit one child per form.
Student Name: *
Campus: *
Required
Headache: *
Uncontrolled cough that causes difficulty breathing: *
Sore Throat: *
Diarrhea: *
Feeling Feverish or Measured Temperature Greater Than or Equal to 100.4 Degrees. *
Known Close Contact with a person who is lab confirmed to have COVID-19 if exposure to the active confirmed case occurred within the last 14 days. *
Submit
Never submit passwords through Google Forms.
This form was created inside of Bangs Independent School District. Report Abuse