Children's Health Screening Form

1. Every school day, answer the following questions, sign and date the form.

2. Submit this form during school drop off

3. If additional forms are needed, reach out to your Family Liaison.

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Question 1:

Does your child have any symptoms of COVID-19 listed here? 

Question 2:

Has your child or anyone in the household traveled outside of ME, NH, MA, NY, CT, NJ or VT in the past month?

Question 3:

Has your child come into contact with anyone who has tested positive with COVID-19?

Question 4:

Is anyone in your child's household experiencing signs of illness?

Question 5:

Does your child have a temperature below 100.4?

Question 6:

Has your child taken any medication in the last 24 hours? If yes, what?

Question 7:

What time did your child last eat or drink?

Choose a time

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