MANDATED WEEKLY HEALTH SCREENING FORM
For Greek School
Sign in to Google to save your progress. Learn more
Today's Date *
MM
/
DD
/
YYYY
Child's Name *
To your knowledge, have you or anyone in your household been in close contact in the past 14 days with anyone who has tested positive for COVID-19 or had symptoms of COVID-19? *
Have you tested positive for COVID-19 in the past 14 days? *
Have you experienced any symptoms of COVID-19 in the past 14 days? Symptoms include, but are not limited to: *
Required
Have you or anyone with whom you have been in close contact in the past 14 days, recently returned from international travel, or from a restricted state to New Jersey State? *
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Middletown Township Public Schools. Report Abuse