Dickerson Daily Health Check Form
**Please complete the following health check prior to arriving at school** If the temperature taken is 100.4F or higher, the student must stay home and get a doctor's note to return to school.
Please select the current date *
Child's Last Name *
Child's First Name *
Grade *
Does your child have a fever of 100.4 or greater? *
Is your child currently experiencing any flu-like symptoms? *
Flu like symptoms include: fever or chills, cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, headache, new loss of taste or smell, sore throat, Congestion or runny nose, nausea or vomiting, or diarrhea.
Has your child traveled out-of-state within the past two weeks to a state on the governor's restricted list? *
Has your child been around someone that has been diagnosed with COVID-19 within the past two weeks? *
If you answered YES to any of the questions, select Yes below. If you answered NO for ALL questions, select No. *
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