Weekend Self-Screening for Students
Please submit this form daily before bringing your child to campus on weekends. The form is date stamped upon submittal.
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Use SchoolPass during the week. This form is only a backup and for weekends now. Thank you for your cooperation. Link to SchoolPass directions: https://docs.google.com/document/d/1p9XmGPzxAQmCbyHFISa50PDcVZwuDzYWuLO2W31xQrk/edit?usp=sharing
Child's LAST Name *
Child's FIRST Name *
Student's Division *
Take the child's temperature before responding. Has the child had a fever above 100.4F in the past 24 hours? *
Is the child experiencing a cough or difficulty breathing (for those with allergies or asthma change from baseline)? *
Does the child show any of the following symptoms this morning: new-onset headache, vomiting; diarrhea; sore throat? *
Is the child referred to by this form awaiting COVID-19 test results? *
In the past 10 days, has the child been in contact with anyone who is awaiting test results or confirmed diagnosed with COVID-19, or are you living in the same residence with someone who has COVID-19 symptoms? (Please see DOH guidelines for exposure). *
Has the child traveled out-of-state in the past 10 days? *
Any other information about the child's current condition that you would like to share:
Parent Name *
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