Belleville Henderson  COVID-19 Screening Questionnaire for Students
COVID-19 Screening Questionnaire Belleville Henderson Students - Under the guidance of the NYS Department of Health, Belleville Henderson District is requiring that parents and students complete this health screening questionnaire every Monday.

Students or Parents: Complete this form prior to reporting to school. If you answer “yes” to any questions, do not report to Belleville Henderson School and notify your supervisor immediately. You must wear a facial covering to enter Belleville Henderson School.

This is a requirement.  Symptoms of COVID-19 may include: headache, 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.

Contact Information: kbertram@bhpanthers.org
Cell phone: 315-486-0513




*****Both remote only and in-person learners need to have this information reported.*****
Sign in to Google to save your progress. Learn more
Email *
Please list your child's name (this form is for one child only). *
Does your child have a temperature of 100 degrees? *
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of Belleville Henderson CSD. Report Abuse