Adult Class Covid Screening Form - CHERRY HILL
Please complete this form no later than 10 minutes before your class start time. Thank you!
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Email *
Student's First Name *
Last Name *
What day is your class on? *
Which class are you signed up for? *
EXPOSURE: Have you been exposed to anyone with a confirmed case of COVID-19 in the past 7 days? *
COVID TESTING: Do you currently have a pending covid test? [IF YES - DO NOT ATTEND] *
TEMPERATURE *
SYMPTOMS: Do you have any of the following? [IF YES TO ANY SYMPTOM - DO NOT ATTEND] *
Required
Any additional notes? *
*Signature Required Below* I attest to the accuracy of the information provided on this page. I further understand that my actions related to Covid safety affect our communities including other students, families, and our teachers and staff. *
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