Daily Health Form
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Our Lady of the Snows Catholic Academy
Nursery-8th Grade | Floral Park, NY
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Daily Family Form
Date
Date Format: MM slash DD slash YYYY
You are filling this out for: 01/27/2021
Parent/Guardian Name
*
First
Last
Parent/Guardian Email
*
Child Name
*
First
Last
Child Grade
*
Nursery
Pre-K A (Amarain)
Pre-K B (Lopes)
Pre-K C (Gately)
Pre-K D (Banes)
Kindergarten A (Bigeni)
Kindergarten B (Danza)
1st Grade A (Sirico)
1st Grade B (Barone)
2nd Grade A (McKeever)
2nd Grade B (Bamberger)
3rd Grade A (Brandt)
3rd Grade B (Paskor)
4th Grade A (Rasa)
4th Grade B (Gaines)
5th Grade A (Morris)
5th Grade B (Flynn)
6th Grade A (Flatley)
6th Grade B (Fragale)
7th Grade A (Frullo)
7th Grade B (Quinn)
8th Grade A (Aichinger)
8th Grade B (Ross)
P
arents:
Please complete this short check each morning and report your child’s information in the morning before your child leaves for school.
If the answer is
YES
to any question , please
do not
bring your child to school and contact your medical professional.
Health Screening Questions
If your child has any of the following symptoms, that indicates a possible illness that may decrease the student’s ability to learn and also put them at risk for spreading illness to others.
Temperature 100.0 degrees Fahrenheit
Sore Throat
New uncontrolled cough that causes difficulty breathing (for students with chronic allergic/asthmatic cough, a change in their cough from baseline)
Diarrhea, vomiting, or abdominal pain
New onset of severe headache, especially with a fever
Shortness of breath
Fatigue
Muscle or body aches
New loss of taste or smell
Congestion or runny nose
Nausea or vomiting
Diarrhea
Does your child have any of these symptoms?
*
No. The student may go to school.
Yes. The student may not go to school.
To the best of your knowledge, in the past 14 days, has your child been in close contact (within 6 feet for at least 10 minutes) with anyone who has tested positive through a diagnostic test for COVID-19 or who has or had symptoms of COVID-19?
*
No. The student may go to school.
Yes. The student may not go to school.
Has your child traveled internationally or from a state with widespread community transmission of COVID-19 per the New York State Travel Advisory in the past 14 days?
*
No. The student may go to school.
Yes. The student may not go to school.
New York State Travel Advisory
YOUR CHILD DOES NOT MEET THE REQUIREMENTS TO GO TO SCHOOL TODAY
*
Confirm: I understand that I have selected YES to one of the questions above, and that my child DOES NOT MEET THE REQUIREMENTS to go to school today.
CAPTCHA
Email
This field is for validation purposes and should be left unchanged.
×