Trinity Lutheran School Daily Health Questionnaire

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Please take a moment to fill out this form to tell us about your child's health today!

Email *

Student Name *

Does the student have a fever of 100.4 degrees or higher without the use of fever-reducing medication?

Yes

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Is the student currently experiencing any of the following symptoms: (check all that apply or "None of the above") *

Muscle aches

Sore throat

Congestion or runny nose

Persistent cough

Chills

Shortness of breath

Headache

New loss of smell or taste

Recent gastrointestinal symptoms such as nausea, diarrhea, or vomiting

Been in close contact with anyone diagnosed with COVID-19 within the last two weeks

Been asked by a medical professional or local health official to self-isolate or quarantine in the last two weeks

None of the above

Required

Please list any other health concerns you would like us to know about your child today.

Send me a copy of my responses.

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