Check-In With Dr. Churchill

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Check-In With Dr. Churchill

Dr. Churchill checks this periodically during school hours.

Students: If this involves suicide or self-harm, please speak with an adult immediately.

If this is an emergency (students or parents/guardians), please call Lancaster County Crisis Intervention (717) 394-2631 or dial 911.

Sign in to Google to save your progress. Learn more

* Indicates required question

Email *

Your email

Your first name *

Your answer

Your last name *

Your answer

I am a

Student

Parent or Guardian

Clear selection

Next

Clear form

Never submit passwords through Google Forms.

This form was created inside of Penn Manor School District. Report Abuse