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Screening Form for COVID- 19

Thank you so much for filling out this form. Please fill this out every week prior to a student attending class. Please call us at (818) 763-1208 with any questions. 

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1
Entry Form
Name of Student
Name of Guardian
Date
In the last 14 days, the student has not tested positive or diagnosed with COVID-19
If student has tested positive, (if vaccinated) they have quarantined for at least 5 days and have produced a negative result.
The student has not come into close contact with anyone who tested positive or diagnosed with COVID-19 in last 7 days
If student has come into close contact with someone testing positive, the student has subsquently received a negative result.
The student does not have or had in last 24 hours symptoms of COVID:fever, cough, shortness of breah, sore throat, nausea, vomiting, diarrhea, tiredness, chills, headaches, body aches, confusion, or loss of taste/smell
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