COVID-19 Back to School Questionnaire

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To keep our students, families, employees, and community safe, we are following state and local health official's recommendations as we reopen schools for 2020-2021. This includes completing a Covid-19 Back to School Questionnaire. Please complete the information below for each child enrolled in at Randall K. Cooper High School for the 2020-2021 school year.

**If you answer yes to any of the questions below, you may be contacted by a school/ district representative for additional information.**

Student Last Name *

Student First Name *

Student Date of Birth: *

YYYY

Parent/ Guardian Full Name: *

Parent/ Guardian Phone Number: *

Has the student been ill in the last 3 weeks?

Yes

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