๐™‹๐™ก๐™š๐™–๐™จ๐™š ๐™˜๐™ค๐™ข๐™ฅ๐™ก๐™š๐™ฉ๐™š ๐™–๐™ฃ๐™™ ๐™จ๐™ช๐™—๐™ข๐™ž๐™ฉ ๐™™๐™–๐™ž๐™ก๐™ฎ before arriving at school
Your responses are safe and confidential.

You must submit ๐‘ป๐‘พ๐‘ฐ๐‘ช๐‘ฌ, ๐’๐’๐’„๐’† on this page, and ๐’๐’๐’„๐’† on the next.
School *
Child's First & Last Name *
Please, only submit one child per form.
Has your child been in close contact with someone with COVID-19 in the last 14 days? *
Does the student feel unwell with any symptoms consistent with COVID-19? *
COVID-19 symptoms include the following: ยค Cough ยค Fever (100.4 or greater) ยค Shortness of breath ยค Chills ยค Fatigue ยค Muscle pain or body aches ยค Headache ยค Sore throat ยค Loss of taste or smell ยค Congestion or runny nose ยค Nausea, vomiting or diarrhea (diarrhea is defined as frequent loose or watery stools compared to childโ€™s normal pattern)ย ย 
Has the student had a fever greater than 100.4 in the past 24 hours? *
in the past 14 days has the student traveled to an area that requires quarantine when returning to VT? *
If unsure ask your school nurse or look up information or you can check the cross-state travel map here: https://accd.vermont.gov/covid-19/restart/cross-state-travel
What is your temperature today?
Don't worry if you can't take your temperature at home. You will be re-screened at the school.
Did you answer YES to any of the above questions OR was your temperature greater than 100.4? *
Next
Never submit passwords through Google Forms.
This form was created inside of Windham Northeast Supervisory Union. Report Abuse