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347-924-5141
Email Us:
talidaycare@hotmail.com
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Covid Health Screening Questionnaire
Contact Us
Home
About Us
Admission
Child Care Enrollment Form
Upload Admissions
General information
Parents Hand Book
Summer Camp Hand Book
Calendar
Student Program
1 to 2 Year
2 to 3 Year
3K Class
4 UPK
Parent Locker
Our School
Immunization Policy
Child Care Enrollment Form
General inquiry
Health Form
Covid Health Screening Questionnaire
Contact Us
Covid health screening questionnaire
Home
Covid health screening questionnaire
Please enable JavaScript in your browser to complete this form.
Child's
*
First
Last
Parents Phone Number
*
Are you or anyone in your household is waiting on a covid test result
Yes
No
If you answer yes your child can not come back to class until you got negative PCR result
Does your child have any of the following symptoms?:
New and persistent cough
Shortness of breath or any difficulty breathing
Fever
Redness in eyes/ discharge
Loss of taste or smell
Headache
Temperature above 100 F.
Rash
Nasal congestion
Diarrhea/upset stomach/vomiting
No symptoms
Have you or anyone in your household tested positive for COVID-19 during the past 10 days
Yes
No
Do you have any reason to believe you or anyone in your household has been exposed to or acquired COVID-19 during the last 10 days ? *
*
Yes
No
To the best of your knowledge have you been in close contact proximity to any individual who tested positive for COVID- 19 during the last 10 days?
*
Yes
No
Have you or anyone in your household cared for an individual who is in quarantine or is a presumptive positive or has tested positive for COVID-19 during the last 10days
*
Yes
No
Have you or anyone in your household traveled out of New York in the past 14 days
*
Yes
No
Are you or any of the household members was in close contact with someone who suspected or confirmed case of Covid-19 ( ex. A sibling having contact with a person at school, a parent at a job, a family member at social gathering)
*
Yes
No
If yes you must stay home for 10 days
Please indicate the name of class your child is in
1 to 2 Years
2 to 3 Years
3k Class
4 UPK
REMEMBER!! One more day of 1 kid staying home is better then 10 days for everyone 🙂 🙂 If you answer yes to any of the questions above please send text message to 347-924-5141 for review
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140-09 69 Avenue , Flushing, New York- 11367
140-11 69 Avenue , Flushing, New York - 11367
147-05 70 road , Flushing, New York - 11367
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