Montessori Children's Room
Mandatory Daily Health Screening 2021/22
Sign in to Google to save your progress. Learn more
This form is to be completed each morning by all students and staff prior to attending school. If any Covid-19 related symptoms are observed please contact the school office before attending.
Students First Name *
Students Last Name *
Child's Classroom *
Has your child or anyone in your home displayed any of the following symptoms in the last 72 hours? Fever, cough, runny nose, congestion, loss of taste/smell, nausea/vomiting, chills, shortness of breath or any other known Covid symptom. *
If "YES" do not come to school today. Please contact the school office.
Has your child had direct contact with any person with known COVlD-19? *
If "YES" do not come to school today. Please contact the school office.
Who has completed this form ?
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Montessori Children's Room. Report Abuse