Health and Wellness Check-In
We ask parents to check temperature and conduct a routine health screening  of their child/dren each morning. After screening for symptoms,  please complete the form for each child attending St. Cassian School by 7:30 AM every school day.  
Please  note that you should keep your child home from school,  if you answer "yes" to any of the questions below.  To report an absence,  please use  "Report an Absence School Form" : https://forms.gle/XpvKfhfLNHvr2SP5A.                                                                    .
Thank you.
Sign in to Google to save your progress. Learn more
Email *
Student's First and Last Name *
Grade *
Required
Has your child exhibited any of the following symptoms in the last 72 hours: fever (T>99.4), cough, vomiting, shortness of breath, difficulty breathing, new olfactory disorder (loss of smell) or new taste disorder (loss of taste) ? *
Has your child exhibited any two of the following symptoms in the last 72 hours: chills, rigors (shivers), myalgia (muscle aches), headache, sore throat, nausea, diarrhea, fatigue, congestion, runny nose
Clear selection
Have you or your child(ren) been in close contact with someone diagnosed with COVID-19, been diagnosed with COVID-19, or been placed on quarantine for possible contact with COVID-19 within the last 10 days? Have you or your child(ren) been asked to self-isolate or quarantine? In the last 10 days, has child(ren) traveled to (or returned from) a foreign counry? *
In the event your child is asked to quarantine by another institution or health professional, I will contact the principal immediately  by email (mllanes@stcassianschool.org) or by calling the school office.
Clear selection
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of St. Cassian school. Report Abuse
Google Forms