Kindergarten Parent COVID Screening

Parents of kindergarten students wishing to bring their child to class the first day of school may do so at 8:30 a.m., after hallways have been cleared.  The following form must be completed and dropped off at the Elementary entry before going to the kindergarten classroom. 

 

Thank you for your cooperation. 

 

You may also use this PDF version of the form.

 

Parent Name:

 

Date:

 

Student’s Name:

 

 

If you answer "YES" to any of the symptoms listed below, or your temperature is 100.4 F or higher, please do not enter building.  Self-isolate at home and contact your primary care physician's office for direction.  You should also:

(1) Isolate (do not leave) at home for a minimum of 7 days since symptoms first appear, AND
(2) Have 3 days without fevers (without the use of medicine) and improvement in respiratory symptoms.

 

IN THE PAST 24 HOURS, HAVE YOU EXPERIENCED:

☐ Fever

☐ New or worsening cough

☐ Shortness of breath

☐ Sore Throat

☐ Diarrhea

☐ None of the above

 

IN THE PAST 14 DAYS,  HAVE YOU HAD CLOSE  CONTACT WITH AN INDIVIDUAL  DIAGNOSED WITH COVID-19?

☐ Yes

☐ No

 

 

IN THE PAST 14 DAYS, HAVE YOU TRAVELED DOMESTICALLY OR INTERNATIONALLY?

☐ Yes

☐ No

 

If yes, please explain:

 

 

Current temperature: ___________