Covid Screening Questions
Please answer the following questions about your family in the past week.
Email address *
What is your family last name? *
Please list the name(s) of your child(ren) enrolled in ICCS. *
Does anyone in your immediate family have any of these symptoms that are not caused by another condition? Check any that apply. If none, check NONE of THESE. *
Within the last 14 days has anyone in your immediate family had contact with anyone that you know had COVID-19 like symptoms? (Contact is being 6 feet or less for more than 15 minutes with a person or having direct contact with fluids from a person with COVID-19.) *
Has anyone in your immediate family had a positive COVID-19 test for an active virus in the past 10 days? *
Within the past 14 days, has a public health or medical professional asked your family to self-quarantine/isolate because of COVID concerns? *
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