COVID-19 Screening

*Participant 1:

*Email:

Participant 2:

Participant 3:

*Have you/your child tested positive for COVID-19 within the last 10 days?:
Yes
No

*Have you/your child been exposed to someone who has tested positive for COVID-19 within the last 10 days?:
Yes
No

*Do you/your child currently have a temperature that’s above 100.0 degrees fahrenheit?:
Yes
No