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Health Screening Form
Montessori Community School - Screening App
Student Information
Email Address
(*)
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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
(*)
Cough
Diarrhea
Fever of 100.4 or above
Lost sense of smell
Lost sense of taste
Muscle Aches or Pains
Nausea or vomiting
Shortness of Breath
Sore Throat
None
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Is anyone in Household Awaiting Test Results
(*)
No
Yes
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