COVID-19 Student Screening Form
Students are required to complete a daily health screening form before reporting to school.  Should ANY responses change to "yes" after submitting this form, you must notify the school immediatly, and you should NOT come to campus.
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Email *
Student First Name *
Student Last Name *
Student ID Number *
Teacher(s) or Room(s) I will be visiting. *
Within the last 14 days, have you had or been diagnosed with COVID-19 by a medical professional or had a test confirming that you have the virus? *
Required
In the last 3 days, have you had or developed one or more of these symptoms: fever of 100 degrees or greater, fatigue, body chills, night sweats, cough, congestion, runny nose, shortness of breath, sore throat, headache, nausea or vomiting, diarrhea, new loss of taste or smell? *
Required
Have you been in close contact (within 6 feet for 15 minutes or more) in the last 14 days with someone who was confirmed to have COVID-19? *
Required
By submitting this form, I certify all information is true and correct to the best of my knowledge.  I acknowledge it is my responsibility to:  1) Tell my teacher immediately if I feel sick. 2) Wash my hands with soap and water or use hand sanitizer each time I enter and leave class.  3) Maintain a minimum of six foot distance from others.  4) Sneeze and cough into a cloth or tissue, or if not available, my elbow. 5) Appropriately wear a face covering while at school, unless eating or drinking.  6) Not shake hands or engage in any unnecessary physical contact. *
Required
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