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Required Covid-19 Screening

ALL STAFF, PARENTS, ADULTS AND CHILDREN MUST SELF-IDENTIFY BEFORE WE ACCEPT YOUR CHILD IN OUR SERVICE.
  • Please answer the following questions: Check the appropriate box. Thank you.
  • If you have answered yes to any of the above questions or have refused to answer:
  • Your child will not be permitted to attend the child care center.
  • By submitting this form I certify that the above statements are true and valid.
  • Date Format: MM slash DD slash YYYY
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