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Daily Health Form

By signing my child in today, I attest that today and in the past 24 hours, neither my child NOR any household member have experienced any of the following symptoms

  • Fever (temp of 100F or above)

  • Cough / sore throat

  • Rapid breathing or difficulty breathing (without recent physical activities)

  • New loss of taste or smell

  • Gastrointestinal distress (nausea, vomiting, diarrhea)

  • New muscle aches

  • Flushed cheeks

  • Headache

  • Runny nose or congestion

  • Fatigue (when accompanied by another symptom)

  • Any other signs of illness

  • Been in contact with someone ill with a respiratory illness

  • Been in close contact with someone confirmed / presumed COVID-19 within 14 days

  • Has traveled to a COVID-19 high risk state

  • Awaiting COVID-19 test results

Thanks for submitting!

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