JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
New Student Orientation COVID Screening
Wednesday, August 19, 2021
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Student's First and Last Name
*
Your answer
Parent/Guardian's First and Last Name
*
Your answer
Grade for the 2021-2022 School Year
*
6th
7th
8th
Are you experiencing any COVID-like symptoms? If yes, contact your family physician for guidance. *
*
Yes
No
Have you been diagnosed or had close contact with COVID-19 in the past 14 days? *
*
Diagnosed
Close Contact
I am fully vaccinated
N/A
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Millville Public Schools.
Report Abuse
Forms
