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Student Health Screening Form
Please submit this form prior to coming onto campus. Upon arriving to campus, your temperature will be checked!
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* Indicates required question
Email
*
Your email
Your Last Name
*
Your answer
Your First Name
*
Your answer
Students select your grade level
*
Grade 9
Grade 10
Grade 11
Grade 12
Required
1. Have you been in close or proximate contact in the past 14 days with anyone who has tested positive for COVID-19 in the past 14 days?
*
Yes
No
Required
2. Have you tested positive for COVID-19 in the past 14 days?
*
Yes
No
Required
3. Have you experienced any of the following symptoms in the past 14 days?
Cough
*
Yes
No
Required
Chills
*
Yes
No
Required
Muscle Pain
*
Yes
No
Required
Fever (higher than 100.4)
*
Yes
No
Required
Sore Throat
*
Yes
No
Required
Loss of Taste or Smell
*
Yes
No
Required
Shortness of Breath or Difficulty Breathing
*
Yes
No
Required
Diarrhea
*
Yes
No
Required
Vomiting
*
Yes
No
Required
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