SACC Daily COVID Questions

Greater Somerset County YMCA School Age Child Care

Daily COVID-19 Screening Questions

To be completed and submitted daily by a parent/guardian. All fields are required. One form per child.

GSCY branch providing School Age Child Care for this child
Child's First Name
Child's Last Name
Parent/Guardian First Name
Parent/Guardian Last Name
Parent/Guardian Email
Parent/Guardian Phone Number
Does your child have a temperature of 100.4 F or higher?
Are you or anyone in your household experiencing any of the following symptoms?: Fever/chills, cough, shortness of breath or difficulty breathing, fatigue, body aches, headache, loss of taste/smell, sore throat, congestion/runny nose, nausea/vomiting, diarrhea
Are these symptoms normal for you or the person in your household (allergies/asthma?)
Has your child been in close contact with a person known to be infected with COVID-19 in the past 14 days?
Have you traveled anywhere that would subject you to the Governors’ incoming travel advisory that all individuals traveling from states with significant community spread of COVID-19 quarantine for 14 days?