Daily Health Check

You MUST Submit before leaving this form or ALL entries will be lost.

Child's full name *

Arrival group *

The CDC has identified the following COVID-19 symptoms

● Fever over 100.4°F

● Chills
● Cough
● Shortness of breath or difficulty breathing
● Fatigue
● Muscle or body aches
● Headache
● New loss of taste or smell
● Sore throat
● Congestion or runny nose
● Nausea or vomiting
● Diarrhea

Before bringing your child to our center, take your child's temperature and screen your child for COVID-19 symptoms. For the health and safety of children, staff, and parents, if your child exhibits any of these symptoms, or any other symptoms of illness, do not bring your child to the center.

Temperature °F *

Check below to confirm your child does not exhibit any sympoms of illness.

Confirmation *

I confirm that I have taken my child's temperature today and screened my child for symptoms of illness. My child does not exhibit any COVID-19 symptoms or any other symptoms of illness.

Electronic signature *

North door 8:00 am	North door 8:15 am	North door 8:30 am
South door 8:00 am	South door 8:15 am	South door 8:30 am