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PRESCHOOL CHECK-IN

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Child Name 1 *

First

Last

AGE *

Child Name 2 *

First

Last

AGE *

Child Name 3 *

First

Last

AGE *

Parent Name *

First

Last

Phone Number *

My child/children has/have not experienced any symptoms associated with COVID-19 within the past fourteen (14) days, which include fever, cough, and shortness of breath among others. *

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