Daily Family Form - Our Lady of the Snows Catholic Academy

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Date

You are filling this out for: 11/29/2021

Parent/Guardian Name*

First Last

Parent/Guardian Email*

Child Name*

First Last

Child Grade*

Parents: 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

Has your child had a fever above 100.3 in the last 24 hours?*

No. The student may go to school.
Yes. The student may not go to school.

Is your child exhibiting and of these symptoms?*

Fever, chills, shortness of breath, difficulty breathing, worsening cough, sore throat, diarrhea, nausea, vomiting, headache, loss of taste or smell.

No. The student may go to school.
Yes. The student may not go to school.

Is anyone in your household experiencing any of these symptoms?*

Fever, chills, shortness of breath, difficulty breathing, worsening cough, sore throat, diarrhea, nausea, vomiting, headache, loss of taste or smell.

No. The student may go to school.
Yes. The student may not go to school.

Has your child been in close contact in the last 14 days with someone diagnosed with COVID-19?*

No. The student may go to school.
Yes. The student may not go to school.

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.

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Email

This field is for validation purposes and should be left unchanged.