Studio East - Daily Health Check

1. Have you had any cold or flu symptoms including fever, cough, sore throat, muscle aches, or congestion that you cannot contribute to another health condition in the last 72 hours? *

YES

2. Have you had close contact or exposure to a person diagnosed with or suspected to have COVID-19 in the last 7 days? *

YES

Student's Full Name *

Signature (Parent/Guardian signature if under age 16) *

clear

Today's Date: * +

By submitting this form, I verify that the above is true and correct.