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Eldred Student COVID-19 Building Entrance Screening Questionnaire
Please complete this questionnaire EACH day that your child is planning on attending school. This form should be completed for EACH child every morning before your child leaves for school.
Thank you for your cooperation and assistance.
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* Indicates required question
Student's First Name
*
Your answer
Student's Last Name
*
Your answer
Please indicate the day for which you are submitting this form
*
Please Note: You should fill this questionnaire out each day your child is planning on coming to school. Thank you
Monday
Tuesday
Wednesday
Thursday
Friday
Required
Destination(s) please check all that apply
*
Mackenzie Elementary School
Eldred Junior Senior High School
Required
If you checked "Yes" to one or more of these questions, your child is NOT permitted to come to school. Please contact your building principal for further instructions. Thank you
Does your child feel feverish or have any symptoms known to be associated with COVID-19 in the past 10 days including a temperature of 100.0 degrees Fahrenheit or greater?
*
Yes
No
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