Parent Responsibility COVID Questionnaire
Please be sure to complete 1 FORM PER CHILD. By completing this form, I attest to the following information:

- My child has not experienced symptoms of COVID-19 including a temperature of greater than 100℉ in the past 14 days. (https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html)

- In the past 14 days my child has not been in close or proximate contact with anyone who has tested positive with a diagnostic test for COVID-19 or who has or had symptoms of COVID-19.

- My child has not tested positive for COVID-19 with a diagnostic test in the past 14 days.

- My child has not traveled internationally (https://www.cdc.gov/coronavirus/2019-ncov/travelers/map-and-travel-notices.html) or from a state (https://coronavirus.health.ny.gov/covid-19-travel-advisory) per the NYS travel advisory in the past 14 days.
Email address *
Student First Name *
Student Last Name *
School *
Grade *
By clicking this button, I attest to the above information. *
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