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Bethlehem Elementary School COVID-19 Questionnaire for Parents May 31st - June 4th.
**UPDATE: Per Emergency Order 89 on Travel Restrictions for New Hampshire there is no longer a restriction on travel and quarantine after travel for NH Public Schools. This means that if anyone in your family travels to any location or anyone comes to your home from any location, you will no longer be asked to quarantine at home for the 10 days-- your student may return to school immediately so long as they are not presenting any symptoms of Covid-19. With these changes, we continue to encourage everyone to remain safe and diligent in preventing the spread of the Covid-19 virus within our school community. All other guidelines at BES remain active. Thank you!**
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Email
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Your email
Name of Individual Filling Out This Form
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Your answer
Name of Student/Students
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Your answer
Have you or your child/children been in close contact with someone who has had a confirmed or suspected case of COVID-19?
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Yes
No
Is there anyone in your household awaiting the results of a COVID-19 PCR (Polymerase Chain Reaction) test?
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Yes
No
Have you or your child/children had a fever or felt feverish in the last 72 hours?
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Yes
No
Have you or your child/children taken any fever-reducing medication within the last 72 hours?
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Yes
No
Have you or your child/children experienced any respiratory symptoms, including a runny nose, sore throat, coughs, shortness of breath, nausea, vomiting, diarrhea, muscle aches or chills, or an unexplained rash?
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Yes
No
Have you or your child/children experienced any new changes in sense of taste or smell?
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Yes
No
I further certify that if I answer YES to any of these questions, had a temperature of 100.4 or higher, were sick or not feeling well, or anyone in my household presents any symptoms listed above, that my child will stay home and not enter the BES facility. I will not give my child fever-reducing medication prior to sending them to school anytime during the week. If my child develops any symptoms and/or fever I will immediately come to pick my child up from the school and will call my PCP or Urgent Care. My child will not reenter the BES facility until School Nurse or Principal authorizes.
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I AGREE to these terms and conditions, and electronically sign this document upon submission.
A copy of your responses will be emailed to the address you provided.
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