Do you or your child(ren) have any flu like symptoms? Fever, chills, cough, shortness of breath, body aches?
□ YES □ NO
Do you or your child(ren) have a cough that you have had for more than a month and if so, is the cough worse in frequency, severity, intensity or in any other way? □ YES □ NO
Have you or your child(ren) felt feverish or have you had a fever in the previous 24 hours? □ YES □ NO
Is your or your child(ren)’s temperature greater than 100.4? □ YES □ NO
Do you or your child(ren) feel short of breath or have difficulty breathing in a way not normal? □ YES □ NO
Do you or your child(ren) have a significant chronic illness? □ YES □ NO
Do you or your child(ren) have a compromised immune system? □ YES □ NO
Have you or your child(ren) been previously asked to self-isolate or self-quarantine? □ YES □ NO
Have you or your child(ren) had an exposure to a person who has a test confirmed diagnosis of COVID-19 in the previous 14 days? □ YES □ NO
Have you or your child(ren) been recently tested for COVID-19? □ YES □ NO
If yes, have you or your child(ren) received results that you tested positive for COVID-19 in the previous 14 days?
□ YES □ NO
Have you or your child(ren) been in contact with someone diagnosed with COVID-19 either within 72 hours before their symptoms started, within 7 days after their symptoms began, or within 3 days after their symptoms ended? □ YES □ NO
Do you or your child(ren) have symptoms that may be due to COVID-19, particularly a cough, difficulty breathing, feeling feverish as well as, in some cases, diarrhea, muscle aches, fatigue, sore throat, or runny nose? □ YES □ NO
Do you or your child(ren) have severe symptoms, such as feeling very ill, noticeably short of breath, chest pain, light-headedness or any other worrisome symptoms for which you would typically seek immediate medical attention at an urgent care or emergency room? □ YES □ NO
If YES to any of the above questions about symptoms or fever above 100.4, entry will be denied.
