Health Screening

Admission Pre-visit Health Screening Form


Please complete this form in its entirety prior to your campus visit. The form must be completed individually for each member in your party.

I am asymptomatic of any illness (cough, fever, sore throat, etc.)required
Is your temperature under 100 degrees?required

Have you:

In the past 24 hours: (Check all that apply)required
Please select up to 5 choices
In the past 48 hours:required
Have you or anyone in your household had a COVID test?​
Are you fully vaccinated against Coved-19?required
Electronic Signatrerequired
By selecting yes under Electronic Signature, I am indicating my signature. I am also agreeing that the information above is true, and I will adhere to the Country Day visitor policy.