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Strides Student Health Screener
Before you leave for Strides, please read and answer the following questions truthfully to the best of your knowledge.
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* Indicates required question
Student's Last Name
*
Your answer
Student's First Name
*
Your answer
Name of Person Completing Survey
*
Your answer
Relationship to Student
*
Self
Parent/Relative
Caregiver
Within the last 10 days have you been diagnosed with COVID-19 or had a test confirming you have the virus?
*
No
Yes
Within the past 14 days, have you had close contact with anyone who was diagnosed with COVID-19 or who had a test confirming they had the virus?
*
No
Yes
Have you had any of these symptoms in the past 24 hours: Fever (greater than 100°F), cough, difficulty breathing, severe headache, a new loss of taste or smell, sore throat, vomiting, diarrhea?
*
No
Yes
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