๐๐ก๐๐๐จ๐ ๐๐ค๐ข๐ฅ๐ก๐๐ฉ๐ ๐๐ฃ๐ ๐จ๐ช๐๐ข๐๐ฉ ๐๐๐๐ก๐ฎ before arriving at school
Your responses are safe and confidential.
You must submit ๐ป๐พ๐ฐ๐ช๐ฌ, ๐๐๐๐ on this page, and ๐๐๐๐ on the next.
* Required
School
*
Choose
Bellows Falls Union High School
Bellows Falls Middle School
Saxtons River Elementary School
Central Elementary School
Westminster Center School
Grafton Elementary School
WNESU / Superintendent's Office
Child's First & Last Name
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Please, only submit one child per form.
Your answer
Has your child been in close contact with someone with COVID-19 in the last 14 days?
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No
Yes
Does the student feel unwell with any symptoms consistent with COVID-19?
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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 childโs normal pattern)ย ย
No
Yes
Has the student had a fever greater than 100.4 in the past 24 hours?
*
No
Yes
in the past 14 days has the student traveled to an area that requires quarantine when returning to VT?
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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
No
Yes
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.
Your answer
Did you answer YES to any of the above questions OR was your temperature greater than 100.4?
*
No
Yes
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