COVID-19 Screening Form 2020-21.           Rockaway Borough --4th Marking Period
To the Parent/Guardian:  Please complete this form, certifying that you will screen your child for symptoms of COVID-19 and will keep your child if any of the criteria are met.  A copy of the district's daily screener is available here:
 https://www.rockboro.org/cms/lib/NJ02201595/Centricity/Domain/8/Covid-19%20Student%20Screening%20Tool%204th%20MP.pdf
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Student first name *
Student last name *
School *
Grade *
I, the parent/guardian of the student listed above, hereby certify that I will conduct a daily screen of my child using the district's COVID-19 Screening Form before my child gets on a school bus or arrives on campus.  I further certify that I will not send my child into school if he or she meets the criteria specified on the Screening Form.  I will contact the nurse's office if my child meets the criteria specified in the Screening Form. *
Parent/Guardian Electronic Signature *
Date *
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