Daily Screening Form-FALL 2021
Please complete this survey before coming to K2E.
Sign in to Google
to save your progress.
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?
Fever (temperature of 100.0°F or above), felt feverish, or had chills
Difficult breathing or shortness of breath
Gastrointestinal symptoms (diarrhea, nausea, and/or vomiting) and Abdominal pain
New loss of smell/taste
Any other signs or symptoms of illness
None of the above
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.
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.
Never submit passwords through Google Forms.
This form was created inside of K2 Enrichment Program.