Covid-19 Resources | Fishkill CCS

Child's First Name

Email Address

Child's Last Name

Date of Birth

Is your temperature 100.0 or above 100.0 today?
Have you knowingly been in close or proximate contact in the past 14 days with anyone who has tested positive through a diagnostic test for COVID-19 or who has or had symptoms of COVID-19?
Have You: experienced any symptoms of COVID-19, including a temperature of greater than 100.0°F in the past 14 days?
Have you traveled internationally or from a state with widespread community transmission of COVID-10 per the New York State Travel Advisory in the past 14 days?
Are you or anyone in your home in active quarantine status?
Has your child had contact with any person with known COVID-19 or person under Investigation for COVID-19?
Is your child's school or childcare program under mandatory closure due to a confirmed case of COVID-19?

Are you able to answer YES to any of the above questions?

Yes

If you answered yes to any question, please elaborate

Parent or Guardian Signature:

Today's Date

I declare that the info I’ve provided is accurate & complete

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