Back-to-School COVID Declaration Form

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Back-to-School COVID Declaration Form

Within 24 hours of arriving on campus for your student's/students' first day back to school, please check for symptoms and complete this short screening form (one per student). Be sure to click "Submit" at the bottom of the last page.

This screening form is only for your child's/children's first day back on campus; this will not be a daily requirement. Thank you and welcome back!

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* Indicates required question

Email *

Your email

Student First Name *

Your answer

Student Last Name *

Your answer

Campus *

Choose

Burbank

Los Feliz - ELC

Los Feliz - main

Pasadena

West Valley

Grade *

Choose

Preschool

PS/PK (Pasadena & ELC only)

Pre-K

K

1

2

3

4

5

6

7

8

9

10

11

12

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