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LCC Kingdom Kids COVID Screening
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* Indicates required question
Email
*
Your email
Student Name
*
Your answer
Parent Name
*
Your answer
Does your child have signs or symptoms of a fever?
*
No
Yes
Have you or your child had a temperature measuring 100.4 or above within the past 48 hours?
*
Yes
No
Have you or anyone in your household experienced any of the following symptoms in the past 24 hours (check all that apply) *
*
cough or sore throat
fatiuge
headache
diarrhea
fever or chills
nausea or body aches
shortness of breath or difficulty breathing
congestion or runny noes
None of the above
Required
In the last two weeks, did you have close contact with someone with symptoms of COVID-19, tested for COVID-19, or diagnosed with COVID-19? *Close contact is when you are within 6 feet of an infected person for at least 15 minutes.
*
Yes
No
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