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Philly KiDZ Initiative
AM REGISTRATION FORM ... CLICK HERE
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Covid-19 Health Declaration
HOW IS YOUR CHILD FEELING TODAY?
CHILD'S NAME
PARENT'S NAME
Email
My child's temperature is lower than 100.4F/ 37.5C
My child is not experiencing the symptoms: fever, cough, sore throat
My family has not been in close contact with a Covid-19 patient in the last 14 days
Initials
Date
I declare that the info I’ve provided is accurate & complete
Submit
Thanks for submitting!
