We're excited to have you join us on campus at St. Peter's Episcopal School.
If you are planning to enter St. Peter's Episcopal School, please take a moment to complete this form just prior to entering. All questions require an answer, and by submitting this form, you attest that all responses have been answered honestly.

This health screening will only be valid for visits to campus occurring on the current date*
Month Day Year
Date

Reason for visiting school*
Student Parent/Guardian Faculty/Staff Admissions/Tour/New Family Event Vendor Special Event Parishioner
5-Digit Carpool Code
This code can be found on your carpool tag
You must complete a new form for each student who will be on campus today.
The QR Code generated by this form is only valid to check-in the one student whose name is entered on the form and only for the current date.

Important Message!

We have added something new. You now select your name from the drop-down list instead of typing it in.
Pick Name
If your name is not listed please use the "other" option.
Full Name*
John Doe
Email*
example@example.com
Phone Number*
What is the zip code of the your residence?*
I will be picking-up and dropping-off this student
Yes No
Please provide a secondary email that a copy of the check-in/out QR Code can be sent to.
Email 2
example@example.com
QR Code Link

Will you be working from home?
Yes I can still work from home No I can not work from home
Select what sick leave pay you wish to use.
Personal Days (max 64 hours) COVID-19 Days (max 80 hours) I've used all my Personal and COVID-19 Days (no pay)
Please upload an image of the test results.
Browse Files
Cancelof
Please list any persons from the St. Peter's Community you have come in contact within 7 days of receiving a positive test.
First Name Last Name Email Phone
Person 1
Person 2
Person 3
Person 4
Person 5
Person 6
Person 7
Person 8
Person 9
Person 10

In the last 14 days have you been in close contact with someone who themselves have received a positive COVID-19 test in the last 14 days?
Yes No
What date did this contact occur?
Year Month Day
Date

Has any member of your family experienced any of the following symptoms in the last 14 days: cough, shortness of breath, difficulty breathing, or two or more of the following: fever, chills, repeated shaking with chills, muscle pain, headache, sore throat, vomiting, diarrhea, or new loss of taste/smell?
Yes No
Are you or any member of your family waiting on test results from a COVID-19 test?
Yes No

You must complete a new form for each student who will be on campus today.

Important Message!