Ohev Shalom Health Questionnaire - Hebrew School/Tichon
IF YOUR ANSWER IS YES TO ANY OF THESE QUESTIONS YOUR CHILD MAY NOT ATTEND HEBREW SCHOOL. THIS FORM MUST BE COMPLETED NO MORE THAN 2 HOURS PRIOR TO ARRIVAL.
Email address *
CHILD'S NAME
Did your child have in the last 72 hours any of the following: fever (100.4 or above), feel warm, have a sore throat, cough, chills, body aches, loss of smell, diarrhea, or vomiting? *
Has your child or someone in your household had close unprotected contact with a suspected or known COVID-19 patient? (spent longer than 15 minutes within 6 feet of someone who is sick with a fever or cough)?
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Within the past 14 days has your child been sick or diagnosed with COVID-19, or are they sharing a residence with anyone who has been sick or diagnosed, or awaiting a COVD-19 test?
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