Religious Education Daily Checklist

Religious Education Daily Checklist
Please complete the required symptom checklist each morning prior to Religious Education and display your screen (mobile device) to the staff member at the Greeting Station. If you are a multi-child household, complete one form for each student.
Student Name *

First Name Last Name
Religious Education Start Time *
Religious Education Class Location *

Within the last three (3) days, has your child experienced any of the following symptoms? *

Yes

Fever or Chills

New uncontrolled cough

Shortness of breath or difficulty breathing

Fatigue, muscle or body aches

New onset of severe headache

New loss of taste or smell

Sore throat

Congestion or runny nose

Diarrhea, vomiting or abdominal pain

A fever of 100.4° F or greater (when taken by mouth) in the last three (3) days

Has the child had close contact within 6’ of an infected person for at least 15 minutes within 2 days BEFORE they developed symptoms or tested positive for COVID-19?

If you answered “Yes” to any question, please e-mail victoria@nativityhollywood.org. Do not bring your student to Religious Education class.
Date *

Month Day Year
Date
Parent Name *
Parent Email *
example@example.com
Should be Empty: