COVID Entry form for ESY (Extended School Year) Students
Last Name (Student) *
First Name (Student) *
Is anyone in your household experiencing a respiratory illness (fever, cough, shortness of breath)? *
Has your student experienced recent fever, headache, cough, sore throat, shortness of breath, muscle aches, stomach ache, loss of taste or smell? *
Has your student taken any tylenol or ibuprofen in the last 4-8 hours? *
Has your student had contact with anyone diagnosed with COVID-19 within the last 14 days? *
Has the student travelled outside of New England, New York or New Jersey in the last 14 days? *
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