Daily Screening Form-FALL 2021
Please complete this survey before coming to K2E.
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Email *
Child's Name *
Today's Date *
MM
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DD
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Has your child or anyone in your household been tested for COVID in the past 10 days or pending a test result for a Covid test? *
If yes please indicate date and test result.
In the past 24 hours, have you or any household members (including your child) had any of the following symptoms? *
Required
In the past 10 days, has your child, you, or anyone in the household traveled to any international counties? *
If yes, please indicate where you/your child has traveled to and the date you/your child has returned to Massachusetts? Please provide a negative PCR test result for your child and/or any household member that traveled to any international countries before he/she returns to K2E.
Additional Information
By entering your name below, you are effectively providing your signature, indicating that your family is in compliance with the Mass travel guidelines, and all the information on this form is true and accurate, to the best of your knowledge. *
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