Have you traveled internationally in the last 14 days? *
Have you or your child been in close contact with another person who has been diagnosed with or under investigation for COVID-19? *
In the last 48 hours, have you or your child had any of the following: A sore throat, cough, fever or chills, shortness of breath, muscle or body aches, difficulty breathing, headache, new loss of taste or smell, congestion, or runny nose? *
If you answered yes to any of the above, please explain.
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of ScratchSpace Inc.. Report Abuse