COVID-19 Screening Declaration for FA K-5 Students
This Screening Tool is offered for informational purposes to help you check for COVID-19 symptoms as outlined by the Centers for Disease Control and will not be shared with the public. All information will only be shared with the your school administration. The guidance you receive depends on the accuracy of the information you provide as well as current guidelines for identifying symptoms associated with COVID-19. Please take the survey and provide the responses before coming into school for the week. This is not a substitute for professional medical advice, diagnosis, or treatment of disease or other conditions, including COVID-19. Always consult a medical professional for serious symptoms or emergencies.

Your child's health and well-being are of the upmost importance and we are taking measures to keep our entire School facility a safe environment for students, employees, as well as, all individuals under our charge and the public. Therefore, anyone coming into the facility may be screened and part of our screening process may include taking your temperature and asking the following questions.
Email address *
Child's First Name: *
Child's Last Name: *
Child's Grade *
Has your child had COVID-19 symptoms in the past 14 days? (The current CDC definition of symptoms includes: fever, cough, shortness of breath, or at least two of the following symptoms: fever, chills, repeated shaking with chills, muscle pain, headache, sore throat, or new loss of taste or smell) *
Has your child had a positive COVID-19 test in the past 14 days? * *
Has your child had close contact with confirmed or suspected COVID-19 cases in the past 14 days? *
Has your child traveled outside of NYS in the last 14 days? * *
If you responded yes to traveling outside NYS, please indicate the location below. *
By checking this box I am confirming the above information is accurate. *
A copy of your responses will be emailed to the address you provided.
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