Parent/ Child's Name *
Your Email
1. Have you been lab-confirmed positive for COVID-19 (for which you have not yet been cleared by a health authority to discontinue home isolation & return to in-person activities)?
YesNo
2. Have you recently completed testing for COVID-19 and are awaiting results? *
YesNoOther
If Other
3. Do You have any of these symptoms? Feeling feverish or a measured temperature greater than or equal to 100.0℉ (please check your temperature to be sure) Loss of taste or smell Cough, difficulty breathing, or shortness of breath Fatigue Headache Chills Sore throat Congestion or runny nose Shaking or exaggerated shivering Significant muscle pain or ache Diarrhea, nausea or vomiting *
YesNo
In the past 14 days, have you had known close contact* with any person with a lab confirmed (active) case of COVID-19?
YesNo
Have you taken any fever reducer medicine in past 24 hrs. *
YesNo