St. Rose of Lima Academy COVID-19 Screening Questionnaire
In order to continue providing the safest environment possible for our students, staff and parents, we ask that you fill out the survey below with the information about your child and yourself prior to returning to school on Monday January 3, 2022 from the Christmas Break.
Email *
Family's Last Name: *
Home Town: *
Phone Number: *
Oldest Child's/Staff Full Name *
Oldest Child's Grade/Staff Position *
2nd Child's Name & Grade (if applicable)
3rd Child's Name & Grade (if applicable)
In the past 24 hours, have you or your child experienced a fever or any flu like symptoms? *
Have you or your child recently been in close contact with anyone who has exhibited any of the above symptoms? *
Have you or your child recently been in close contact with anyone who has tested positive for COVID-19? *
Have you or your child recently traveled outside of the New Jersey, Pennsylvania, New York, Connecticut or Delaware area? *
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