Roy Cloud (RCSD) Daily Student Screening Form
All parents/guardians must complete this survey for EACH DAY that their child comes to school. If your child is experiencing symptoms of COVID-19/and or has been exposed to anyone with COVID-19, YOU MUST KEEP YOUR CHILD AT HOME and call the school office.

Please read the question fully before answering, and check for symptoms and your child’s temperature prior to coming to school. Please complete this form prior to your child returning to school. By marking “No” you are confirming that your child is not experiencing any of the symptoms listed, including a fever, nor has your child been in close contact with a symptomatic or COVID positive person.  If you mark “yes” please keep your child at home and notify the school office immediately.

PLEASE COMPLETE 1 FORM FOR EACH CHILD.

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Email *
Student First Name *
Student Last Name *
Grade Level *
People have reported a wide range of COVID-19 symptoms ranging from mild symptoms to severe illness. Symptoms may appear 2-14 days after exposure to the virus. These symptoms could include fever or chills, cough, headache, sore throat, shortness of breath or difficulty breathing, loss of taste or smell, muscle pain, congestion or runny nose, rash, conjunctivitis or pink eye, nausea or vomiting, diarrhea, abdominal pain or stomach ache, or fatigue.   Please answer the following question: Is your child currently experiencing COVID symptoms (listed above) or has your child knowingly been in close contact with anyone who has been diagnosed with, has had COVID-19 symptoms in the last 14 days, or has been placed in quarantine for possible exposure to COVID-19 within the last 14 days?
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Parent/Caregiver Full Name *
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