Daily Self-Screening Questionnaire

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Dear Parent(s) or guardian:

Please complete this COVID-19 Self-Screening Questionnaire everyday for/with your child(ren). If you have more than one child, you will have to complete a separate questionnaire for all of your children. For example, if you have two children, you will have to complete this questionnaire twice.

This self-screening will help to minimize risks to our school population. Gobind Sarvar is following a "Strict At Home Policy", so if you answer yes to any of the questions, it is recommended that you keep your child home that day. If you answer no to all of the questions, then your child may come to school.

Thank you for your support.
Gobind Sarvar School Administrative Team

What is your child's name? (First and Last Name) *

What Grade is your child in? *

Self-Screening Questionnaire

Please read the following questions.

If you answer YES to any of these questions - please DO NOT send your child to school.

If you answer NO to all of these questions - your child may attend school. Thank you!

Please check the box below to confirm that you have read through the COVID-19 Self-Screening Questionnarire. *

I (as the parent/guardian) confirm that I have completed the self-screening questionnaire for my child.

Required

Thank you!

Thank you for completing the COVID-19 questionnaire. Please complete this questionnaire daily.

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Gobind Marg Charitable Trust Foundation. Report Abuse

Forms