Student Wellness Daily COVID Prescreen Form: IJA - One per student
In response to the COVID-19 situation and guidance issued by public health officials, and as
part of our efforts to prevent the spread of COVID-19, we are asking that you take your
temperature before bringing your child to school.

Check your child's temperature at home. If it is 100.4 degrees or higher, keep your child home. You will not be allowed to return to school until your temperature has returned below 100.4 degrees for at least 72 hours without the aid of fever reducing medicine.

If you have any questions regarding your health, please contact your medical provider for information.
Sign in to Google to save your progress. Learn more
Email *
Student's Last Name *
Student's First Name *
Who is your child's teacher *
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of Mt. Pleasant Elementary School District. Report Abuse