Health Care Worker Parent Survey: March 2020
Information for daily educational programs in Monett Elementary for Health Care/Long Term Care/First Responder/Emergency/Law Enforcement parents who need childcare for students in grades Pre-Kindergarten through 6th.
Is your child a current Monett R-I Student
Student I Name
Your answer
Student II Name
Your answer
Student III Name
Your answer
Student I Current Grade
Student 1 health concerns or dietary restrictions:
Your answer
Student II Current Grade
Student II health concerns or dietary restrictions:
Your answer
Student III Current Grade
Student III health concerns or dietary restrictions:
Your answer
Non-Monett Students: What school do they currently attend?
Your answer
Home language (primary language spoken at home)
Your answer
Parent/Guardian Name(s)
Your answer
Parent/Guardian Phone Number
Your answer
Parent/Guardian Email
Your answer
Place of Employment: **Must be Health Care/Long Term Care/Law Enforcement/First Responder
Your answer
Days of the Week Childcare Will Be Needed
Drop Off Time
Time
:
Pick Up Time
Time
:
Submit
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