Little Kings & Queens
This form is mandatory for entry into Little Kings & Queens Daycare and must be filled out DAILY in its entirety
Covid-19 Health Declaration
How are you feeling today?
Child's First Name
Child's Last Name
I declare that my child/myself has not had any of the following symptoms in the past 14 days: Fever, runny nose, vomiting, cough, shortness of breath, sore throat, chills, loss of taste or smell. I also declare that no one in my household has had these symptoms in the past 14 days.
I declare my child/myself has not had direct contact with someone that tested positive for COVID-19 in the past 14 days?
I delclare my child/myself has not been diagnosed with COVID-19 in the past 14 days?
I declare my child/myself has not traveled in the past 14 days?
I declare that my child/myself has been practicing social distancing and wearing a mask outside of my home for the past 14 days.
I declare that the info I’ve provided is accurate & complete.
Thanks for submitting!