INTAKE QUESTIONS

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- Please Mark The Date of Today's Orientation Session Your Child(ren) is Attending Only. Do not mark for future Orientation Dates. REQUIRED Please fill out this field. Please enter a date.
- Session Attending REQUIRED Please fill out this field.
- CHILD'S LAST NAME REQUIRED Please fill out this field. Please enter valid data.
- Students
  
  Child 1 First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Grade REQUIRED Please fill out this field.
  
  Child 2 First Name Please enter valid data.
  
  Grade
  
  Child 3 First Name Please enter valid data.
  
  Grade
- Question #1 - Do you or your child live with anyone or have you or your child had close contact with anyone with a prolonged cough, fever, flu-like symptoms or been diagnosed with COVID-19 within the last 14 days?
- Answer REQUIRED Please fill out this field.
- Question #2 - Do you or your child live with anyone, have had close contact or do you or your child have a fever, cough and/or shortness of breath? For children and adults, fever is 100.4 degrees or above using a forehead thermometer.
- Answer REQUIRED Please fill out this field.
- Question #3 - Do you or your child live with anyone, have had close contact or do you or your child have any other signs of communicable illness such as a cold, flu, rash or inflammation?
- Answer REQUIRED Please fill out this field.
- Question #4 - Do you or your child live with anyone, have had close contact or have you or your child experienced diarrhea or vomiting (within the past 24 hours)?
- Answer REQUIRED Please fill out this field.
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