Parent/Guardian Attestation

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K-12 Schools Symptom Screening

Child's Name *

Has your child had close contact (within 6 feet for at least 15 minutes) in the last 14 days with someone diagnosed with COVID-19, or has any health department or health care provider been in contact with you and advised you to quarantine? *

Yes > The child should not be at school. The child can return 14 days after the last time he or she had close contact with someone with COVID-19, or as listed below.

No > The child can be at school if the child is not experiencing symptoms.

Does your child have any of these symptoms?

If a child has any of these symptoms, they should stay home, stay away from other people, and you should call the child's health care provider

Fever or chills

New cough

Shortness of breath or difficulity breathing

Fatigue

New loss of taste or smell

Sore Throat

Muscle or body aches

Congestion or runny nose

Headache

Nausea or vomiting

Diarrhea

Since they were last at school, has your child been diagnosed with COVID-19? *

If a child is diagnosed with COVID-19 based on a test, their symptoms, or does not get a COVID-19 test but has had symptoms, they should not be at school and should stay at home until they meet the criteria below.

Yes

A child can return to school when a family member can ensure that they can answer YES to ALL three questions:

1. Has it been at least 10 days since the child first had symptoms?
2. Has it been at least 24 hours since the child had a fever (without using fever reducing medicine)?
3. Has it been at least 24 hours since the child's symptoms have improved, including cough and shortness of breath?

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