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* 1. School your student attends:

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* 2. Student Name:

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* 3. Parent/Guardian info.

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* 4. Has your student experienced any of the following in the past 24 hours?

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* 5. Has the person been in close contact with any other individual known to have COVID-19 in the past 24-hours?

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* 6. Has the person been instructed by local health officials to quarantine or isolate within the past 24-hours?

If the answers to any of these symptoms or questions is "Yes", remain at home and notify the school.
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