RVCSD Student Health Screening
Parents/guardians are required to complete this form BEFORE sending their child(ren) to school. Please submit the form ONLY on days your child(ren) are scheduled to attend school in-person.

IF YOU HAVE MORE THAN ONE CHILD IN THE DISTRICT, YOU WILL BE REQUIRED TO FILL OUT A SEPARATE HEALTH SCREENING FOR EACH CHILD.
Student First Name *
Student Last Name *
Your child's school *
Have you had experienced a fever of 100 degrees or greater, new cough, new loss of taste or smell, or shortness of breath within the past 10 days? * *
Have you received a positive result from a COVID-19 diagnostic test that was administered by a nose or throat swab? (Not a blood test) * *
To your best knowledge, in the past 14 days have you been in close contact (within 6 feet for at least 10 minutes) with anyone while they had COVID-19? * *
In the past 14 days have you returned from a destination that is included in the NYDOH COVID-19 Travel Advisory? * *
If you answered yes to any of the questions, please contact your school nurse and do not send your child to school.
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