Daily Health Screening - Freshmen Summer Programming

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Please complete the following form before your student leaves for the bus in the morning. If your student has a temperature of 100.4 or higher or exhibits any of the following symptoms, we are asking that you keep them home.

Email *

Student Name *

Summer Program Name *

Today's Date *

YYYY

Time *

Time

Fever, Cough, Chills, and/or Muscle aches *

Yes

Sore throat, runny nose, and/or loss of taste or smell *

Yes

Nausea, vomiting, and/or diarrhea *

Yes

Shortness of breath and/or headaches *

Yes

Close contact, or cared for someone with COVID-19 *

Yes

Temperature *

A copy of your responses will be emailed to the address you provided.

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