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How We Go Back to School

COVID-19 Screening Questionnaire (Virtual Week (1/18-1/21) Return to School)

Student Name*

Screening Questionnaire

If you checked yes for any of the questions above, please continue to answer the following questions. If no boxes are checked, please scroll down, eSign, and submit.

Has your child been tested for COVID-19?

Was the test Positive or Negative?

On what date did you receive the results?

Parent/Guardian Email Address*


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