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STUDENT COVID-19 CHECKLIST
anthonyjohnson
2021-08-23T13:38:02-04:00
Student Check In
Student Check In (English)
Covid 19 Precaucion
Date
*
Child's Name
First name
*
Last name
Child's Date of Birth
*
Has your child been exposed to to someone who has tested positive for Covid-19? *
*
Yes
No
Is your child experiencing a cough? *
*
Yes
No
Is your child experiencing chills? *
*
Yes
No
Is your child experiencing fever? *
*
Yes
No
Is your child experiencing a new loss of taste or smell? *
*
Yes
No
Is your child experiencing shortness of breath or difficulty breathing? *
*
Yes
No
Durham HS & EHS Center/Event?
*
Christan Prep
Dance with Daddy Party
Durham HS at RTP
Leathers Meachem
Lyon Park
McDougald Terrace
Oxford Manor
Seminary
Current temperature?
*
Confirmation
*
I confirm that I have answered the questions on this form truthfully and to the best of my knowledge.
Thank you for your message. It has been sent.
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Submit
Verificación para Estudiantes (español)
Precaución de COVID-19
Fecha
*
Nombre del Estudiante
Nombre
*
Apellido
*
Fecha de Nacimiento
*
¿Ha tenido su hijo/a contacto con alguien que ha dado positivo al COVID-19?
*
Si
No
¿Tiene su hijo/a algún síntoma a toz?
*
Si
No
¿Tiene su hijo/a algún síntoma a escalofríos?
*
Si
No
¿Tiene su hijo/a algún síntoma a fiebre?
*
Si
No
¿Tiene su hijo/a algún síntoma a perdida de olor o sabor?
*
Si
No
¿Tiene su hijo/a algún síntoma a corto de respiración o dificultad para respirar?
*
Si
No
¿Durham Head Start o Early Head Start/Fiesta?
*
Christan Prep
Dance with Daddy Party
Durham HS at RTP
Leathers Meachem
Lyon Park
McDougald Terrace
Oxford Manor
Seminary
Temperatura actual
*
Confirmación
*
Yo confirmo que he contestado las preguntas sinceramente y a mi mejor conocimiento.
Thank you for your message. It has been sent.
×
There was an error trying to send your message. Please try again later.
×
Submit
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