This Google Form is being used by the school to collect 'baseline health information' so we are better able to distinguish between typical baseline symptoms for your child and COVID-like symptoms.

As part of the home-school partnership, and per the Alberta Government's document entitled COVID-19 Information - Student Illness (click on this link to view: https://esbchs.blackgold.ca/wp-content/uploads/2020/09/edu-covid-19-student-illness-2020-0903.pdf ), parents are asked to supply this baseline health information for students who have allergies or a pre-existing medical condition. The document states that:

The student should be tested at least once before returning to school and have a negative COVID-19 test result. These symptoms would be their baseline health status. As long as the cough or runny nose is always the same and does not get worse, the student can attend school.

Please complete this document IF YOUR CHILD HAS ALLERGIES OR A PRE-EXISTING MEDICAL CONDITION that could present as any of the following COVID-19 symptoms:

Primary Symptoms:
- Fever
- Cough
- Shortness of breath or difficulty breathing
- Runny nose
- Sore throat

Other Symptoms:
- Chills
- Painful swallowing
- Stuffy nose
- Headache
- Feeling unwell, fatigue or severe exhaustion
- Gastrointestinal symptoms (nausea, vomiting, diarrhea or unexplained loss of appetite)
- Loss of sense of smell or taste
- Conjunctivitis (commonly known as pink eye)

PLEASE NOTE: The information collected on this document will be kept confidential.