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Weekly Student Health Check
This form must be completed every Sunday evening by 9PM in order for your child to attend school on Monday each week. If you have multiple children enrolled in the school, please fill out a form for each student. Thank you for taking your part to ensure the health and safety of our school community.
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* Indicates required question
Today's Date
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MM
/
DD
/
YYYY
Parent's First Name
*
Your answer
Parent's Last Name
*
Your answer
Parent's Email Address
*
Your answer
Student's First Name
*
Your answer
Student's Last Name
*
Your answer
Homeroom Teacher
*
Your answer
Grade
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Nursery
Pre-Kindergarter
Kindergarten
1
2
3
4
5
6
7
8
Does your child have a temperature greater than 100⁰F?
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Yes
No
Does your child feel well today?
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Yes
No
Other:
Has your child come in close, regular contact (within 6 feet) of someone who has a laboratory confirmed COVID-19 diagnosis within the past 14 days?
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Yes
No
Does your child have any of the following: fever or chills, cough, shortness of breath or difficulty breathing, body aches, headache, new loss of taste or smell, sore throat?
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Yes
No
Has your child traveled to any of the states on currently on the Advisory List in the last 14 days? The Advisory List is updated and available on the Parent Page on our website at
www.stthomasschool.net
.
*
Yes
No
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