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Daily Attestation Formkidadmin2020-10-06T15:48:43-04:00

Daily Attestation Form

Per EEC, you must fill out this form in its entirety before you can come to work each day.
***If you check any of the symptoms below, you must follow protocol to call out for the day.

Name *

Child's Full Name *

Email *

Have you observed symptoms in yourself or household members in the past 24 hours? *

Fever (100 and higher), feverish, chills
Cough
Sore Throat
Gastrointestinal distress (nausea, vomiting, or diarrhea)
New loss of taste or smell
New muscle aches
Fatigue (in combination with other symptoms)
Headache (in combination with other symptoms)
Runny nose or congestion (in combination with other symptoms)
Any other signs of illness (in combination with other symptoms)
None of the above

Please list where you have been (excluding your primary residence) since you were last at the school. *

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Contact: (781) 861-0695
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