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Health Screening Form
Montessori Community School - Screening App
Student Information
Email Address
(*)
Invalid email address
Student Name
(*)
Student name required
Class
(*)
Moons
Stars
Suns
Aspens
Magnolias
Sequoias
Willows
Oquirrh
Uinta
Wasatch
Student's class is required
Health Questions
Check any symptoms that your child is currently experiencing
(*)
Congestion or runny nose
Cough
Chills
Diarrhea
Difficulty breathing
Fever of 38˚C/100.4˚F or higher
Headache
Lost sense of taste or smell
Muscle aches or pains
Nausea or vomiting
Shortness of breath
Sore throat
None
Invalid Input
I have taken my child's temperature today
(*)
No
Yes
Required question
My child has had recent close contact with someone confirmed with COVID-19
(*)
No
Yes
Invalid Input
Is anyone in the household awaiting COVID-19 test results?
(*)
No
Yes
Invalid Input
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