How many students to confirm? *
For large families, you may have to use this form multiple times.
Parent/Guardian Email
Student Number (Pin)
I certify my child(ren) has not been exposed to anyone with Covid-19 within the past two weeks and is not experiencing the following symptoms:
  • Fever of 100+
  • Cough, new or worsening
  • Difficulty breathing or shortness of breath
  • Chills or muscle aches
  • Extreme fatigue
  • Sore throat
  • Diarrhea
  • Loss of taste /sense of smell
  • Vomiting
  • New onset headache
It is safe for these children to attend school today *
Note: You still must report any absences to the front office.
IDPH Guidance
* Required field(s)
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Forma Espaola Students in Grades 5-8 need to be submitted by 7:00am. Grades PK - 4 by 8:00am