Student Entry Screening Form
Complete this form by 7:15 am for each day that your student is on campus.
A separate screening form must be completed for each student.
Student will not be allowed entry without a submitted form.
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Student Name *
Student Grade *
Car Line Number *
Does your student have any of these symptoms (not related to chronic, known conditions or seasonal allergies): chills, muscle aches, sore throat, nausea, fatigue, congestion/runny nose, fever (100.4 or greater), cough, shortness of breath, difficulty breathing, new loss of taste/smell, vomiting, diarrhea? *
Has your student or anyone in your household tested positive for COVID 19 in the last 14 days OR have had close contact (within 6 feet for 15 minutes or more) with a confirmed or suspected COVID 19 case in the last 14 days? *
Answered yes?
If you have answered yes to any of the above questions, please keep your student home and notify the school for further instructions.
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