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COVID-19|Daily Questions
Please fill this out for each child
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Email
*
Your email
Please enter today's date:
*
MM
/
DD
/
YYYY
CHILD|Last Name
*
Your answer
CHILD|First Name
*
Your answer
Have your child or anyone in your home had fever of 100 or more, dry cough, chills, vomiting, diarrhea, or rash in the last 24 hours?
*
20 points
Yes
No
Have you or anyone with whom you have had direct and regular contact been confirmed or presumed to be positive for COVID-19?
*
10 points
Yes
No
Is anyone in your household family or anyone with whom you've had direct contact with waiting to receive Covid-19 test results?
*
10 points
Yes
No
Have you or anyone with whom you have had direct and regular contact traveled outside of the United States in the past 2 weeks?
*
20 points
Yes
No
Has anyone in your house hold been asked to self isolate or quarantine by a medical professional or local health official?
*
20 points
Yes
No
Has your family traveled out of Texas or country in the past 14 days?
*
20 points
Yes
No
By checking yes, I acknowledge that I dropped my child off at Fair Haven Day School today
*
Yes
No
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