Ms. Burns Pre-k 3 April Student Health Screening Form
Please complete and submit every morning before 8:15am
כדי לשמור את הטיוטה אפשר להיכנס לחשבון Google. מידע נוסף
אימייל *
Student Name *
Is your child , or a household member currently waiting for the results of a COVID-19 test? *
 In the past 10 days, Has your child experienced any symptoms of COVID-19 , including a fever of 100.0 F or greater, new cough, loss of taste or smell, shortness of breath, sore throat, headache, nasal congestion, runny nose (sniffles), stomach upset? *
In the past 10 days has your child gotten a lab confirmed positive COVID-19 test result (not  a blood test) that was their first positive COVID-19 result OR was 90 days from their previous positive COVID-19 result? Please note the 10 days is measured from the day you were tested, not the day you received the results. *
To the best of your knowledge , in the past 10 days has your child been in close contact (within 6 feet for at least 10 minutes over 24 hour period) with anyone who has tested positive for COVID -19 or who has been told they have symptoms of COVID-19 ? *
In the past 10 days has your child or a household member returned from an international destination? *
עותק של התשובות שלך יישלח באימייל לכתובת שציינת.
שליחה
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הטופס הזה נוצר בתוך Holy Child Jesus Catholic Academy. דיווח על שימוש לרעה
Google Forms