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Daily Screening - Students
All parents must self-complete this screening and submit this form by 8 a.m. every day before bringing their student to school.
The school will send home any employee or child who has any new or worsening signs or symptoms of possible COVID-19 starred below. Those with other symptoms listed must meet with Ms. Laufersky to discuss whether they are able to attend school that day.
Source: Texas Health and Human Services/Governor’s Strike Force to Open Schools
https://gov.texas.gov/uploads/files/organization/opentexas/OpenTexas-Checklist-Child-Care-Centers.pdf
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* Indicates required question
Student's Last Name
*
Choose
Allison
Bennett
Boothe
Bosco
Brammer
Buttrey
Coke
Connery
Crenshaw-Lofgren
Crenshaw-Lofgren
Crutchfield
Dehm
Derr
Diaz
Dunham
Fenley
Flint
Garcia-Chu
Godoy
Gomez
Good
Graham
Guy
Hartgrove
Herron
Janeway
Janeway
Kennedy
Kirk
LaCroix
Lewicki
Lowes
Lowes
McKane
McKane
O'Connor
O'Connor
Page
Page
Palmer
Panatier
Parker
Parker
Phillips
Pratt
Pratt
Reeves
Reeves
Reilly
Rodriguez
Rodriguez
Rogers
Roodhuyzen
Sergie
Snedden
Tunks
Vazquez
Weinstein
Whitmore
Travel disclosure: I, and/or my children, have traveled in the past two weeks.
*
Yes
No
If you answered "yes" to the above question, please share the details of your travel, including dates, location, mode of travel (air, car, train, etc), and activities engaged in.
Your answer
If you have a question about upcoming scheduled or potential travel, please send it to
schoolnurse@whiterockmontessori.org
.
Your answer
WRM Social Contract
*
Checking this box demonstrates acknowledgement of and agreement to following WRM's Social Contract
Required
My student(s) will be at school today.
*
Yes
No
If you answered no, please tell us why.
Your answer
Are you or your child/ren experiencing any of the following new or worsening signs or symptoms of possible COVID-19?
*
A student will be sent home if they have any of the starred symptoms OR at least two of the unstarred symptoms.
Yes
No
Fever or chills
Cough
Shortness of breath or difficulty breathing
Fatigue
Muscle or body aches
Headache
New loss of taste or smell
Sore throat
Congestion or runny nose
Nausea or vomiting
Diarrhea
Known contact with a person who is lab-confirmed or presumed to have COVID-19
Being evaluated or been diagnosed for COVID-19 in the past 14 days
Yes
No
Fever or chills
Cough
Shortness of breath or difficulty breathing
Fatigue
Muscle or body aches
Headache
New loss of taste or smell
Sore throat
Congestion or runny nose
Nausea or vomiting
Diarrhea
Known contact with a person who is lab-confirmed or presumed to have COVID-19
Being evaluated or been diagnosed for COVID-19 in the past 14 days
If there is any additional information you would like to share with us about the question above, please do so here.
Your answer
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