Daily Health Screening
Has your child had close contact (within 6 feet for at least 15 minutes) in the last 14 days with someone dignosed with COVID-19, or has any health department or health care provider been in contact with you and advised your family to quarantine?
YES
NO
Since your child was last at school, have you or any family member had any of these symptoms?
Fever
Chills
Shortness of breath or difficulty breathing
New cough
New loss of taste or smell
Since your child was last at school, has anyone in your immediate family been diagnosed with COVID-19?
Yes
No
Child's Name
First Name
Last Name
Please record your child's temperature prior to leaving for school.
By signing below, I acknowledge the information above is accurate and that I play a vital role in the health of the entire Ivybrook community.
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