In-person activity compliance screener

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Required to participate in the Day of Silence event on Friday 4/23/21.

Email *

Student Name *

Name of family member completing form *

Has your child been exposed to anyone with COVID-19 in the past 10 days or been considered a Close Contact of someone with COVID-19 in the past 10 days? Here are the close contact details https://www.dhs.wisconsin.gov/covid-19/close-contacts.htm *

Yes

Required

Is your child feeling sick with any of these symptoms?(Any of these symptoms alone, even a runny nose or congestion, can be an indication of COVID-19, so it is important to stay home to avoid spreading illness to others. Students showing symptoms of illness at school will be sent home.) Here is a full list of symptoms https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html (Check all symptoms currently experiencing) *

Cough

Shortness of breath or problems breathing

Chills

Sore throat

Loss of taste or smell

Muscle pain or body aches

Headache

Fever (at or above 100.4 degrees F) or chills (or have they used fever-reducing medications like Aspirin, Ibuprofen, or Tylenol within the last 24 hours?)

Runny nose or nasal congestion

Nausea or vomitting

Diarrhea

No symptoms

Required

Has your child tested positive for COVID-19 in the past 10 days? *

Yes

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