Ferntop Daily Screening
You are welcome to fill out this form at home before coming to Ferntop.  We only need one per family per day if all answers are the same for your children.

Please do not leave school grounds before completing this form. Thank you!
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Class (check all that apply) *
Required
What is your child’s name? *
Has your child presented with any one of the following symptoms recently? Pink Eye, Colored Discharge from nose or eyes unrelated to allergies, Persistent, disruptive cough, Shortness of breath, Difficulty breathing, Fever of 100.4 or greater, Chills, Nausea and diarrhea , Undetermined rash *
Has your child displayed two or more of the following symptoms recently? Headache, Sore Throat, Muscle Aches, New loss of taste or smell *
You are required to check your child’s temperature before bringing them to Ferntop each day. Was your child’s temperature above 100.4 degrees today? *
To the best of your knowledge, has anyone in your household been exposed to COVID-19? (If your answer is yes, please call Clare right away to discuss.  978.758.9645) *
What is your name? *
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