* Required

Parents/Guardians: Please complete this short checklist to report your child’s absence and symptoms. Please complete a new form for each child in your house that attends SRDS. Questions? Please contact Nurse Ann Hanna (201) 327-4050 x2911 or ahanna@saddleriverday.org

Section 1: Symptoms

Any of the symptoms below could indicate a COVID-19 infection in children and may put your child at risk for spreading illness to others. Please note that this list does not include all possible symptoms and children with COVID-19 may experience any, all, or none of these symptoms. Please check your child daily for these symptoms:

Check all the apply​​​​

Section 2: Close Contact/Potential Exposure

*Area of high community transmission

Please verify if​

If ANY of the fields in Section 2 are checked off, your child should remain home for 14 days from the last date of exposure (if child is a close contact of a confirmed COVID-19 case) or date of return to New Jersey.

Contact your child’s provider or your local health department for further guidance.