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COVID Student Questionnaire
Our Lady of Confidence requires this form to be filled out every Sunday night into Monday morning before your student enters the Lower School or High School building. We appreciate your understanding.
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* Indicates required question
Email
*
Your email
Name of the Student
*
Your answer
Is your student experiencing any one of these symptoms? Fever over 100.4, chills, shortness of breath, persistent cough, vomiting, diarrhea, loss of taste.
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Yes
No
Is your student experiencing 2 or more of these symptoms? Headache, sore throat, fatigue, congestion or runny nose
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Yes
No
Has your student traveled to a restricted "hot spot" for COVID within the last 10-14 days?
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Yes
No
Has your student been in contact with anyone who has COVID within the last 10-14 days?
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Yes
No
I acknowledge that I have read the COVID-19 Health Monitoring guidelines above and will adhere to them. In signing this document, I am assuring the school that my student is qualified, is in good health, and in proper physical condition to participate in Our Lady of Confidence School Activities. Additionally, I assure Our Lady of Confidence School that my family is following all CDC recommended guidelines and limiting my student’s exposure to risks for COVID-19.
*
Agree
Disagree
Required
Please type in the name of the person completing this form and today's date.
*
Your answer
A copy of your responses will be emailed to the address you provided.
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