{"id":2655,"date":"2020-10-09T09:58:54","date_gmt":"2020-10-09T09:58:54","guid":{"rendered":"https:\/\/104-237-149-129.ip.linodeusercontent.com\/?page_id=2655"},"modified":"2020-10-29T18:00:36","modified_gmt":"2020-10-29T18:00:36","slug":"daily-check-in-questionnaire-for-students","status":"publish","type":"page","link":"https:\/\/abcgrowingtree.com\/index.php\/daily-check-in-questionnaire-for-students\/","title":{"rendered":"Daily Check-in Questionnaire For Students"},"content":{"rendered":"<div class='grid-row clearfix'><div class='grid-col grid-col-12'><div class='cws-widget'><div class='cws_widget_content'>\n\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f2679-o1\" lang=\"en-US\" dir=\"ltr\" data-wpcf7-id=\"2679\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/index.php\/wp-json\/wp\/v2\/pages\/2655#wpcf7-f2679-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Contact form\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"2679\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.5\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f2679-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/><input type=\"hidden\" name=\"_wpcf7_recaptcha_response\" value=\"\" \/>\n<\/fieldset>\n<p><span class=\"wpcf7-form-control-wrap\" data-name=\"date-303\"><input class=\"wpcf7-form-control wpcf7-date wpcf7-validates-as-required wpcf7-validates-as-date\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"date\" name=\"date-303\" \/><\/span><br \/>\n<b> Student First Name <\/b><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"First-Name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"First-Name\" \/><\/span>\n<\/p>\n<p><b> Student Last Name <\/b><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Last-Name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"Last-Name\" \/><\/span>\n<\/p>\n<p><b> Parent\/Guardian Name <\/b><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"parent\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"parent\" \/><\/span>\n<\/p>\n<p><b> Student Class <\/b><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"class\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"class\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"School Age\">School Age<\/option><option value=\"PreK\">PreK<\/option><option value=\"Preschool 2\">Preschool 2<\/option><option value=\"Preschool 1\">Preschool 1<\/option><option value=\"Toddlers\">Toddlers<\/option><option value=\"Little Tots\">Little Tots<\/option><option value=\"Infants\">Infants<\/option><\/select><\/span>\n<\/p>\n<p><b> Age Group of your child <\/b><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Age\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"Age\"><option value=\"0 \u2013 2.5\">0 \u2013 2.5<\/option><option value=\"2.5 \u2013 5\">2.5 \u2013 5<\/option><option value=\"6 \u2013 13\">6 \u2013 13<\/option><\/select><\/span>\n<\/p>\n<p><b> Have you given the above child any medication that could possibly lower their temperature? <\/b><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Medication\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"Medication\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"Medication\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><b> Has the child been coughing, showing signs of shortness of breath, difficulty breathing, new loss of taste or smell? <\/b><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Symptoms-Child\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"Symptoms-Child\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"Symptoms-Child\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><b> Please mark any and all of the symptoms they are experiencing. <\/b><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Signs-Child\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"Signs-Child[]\" value=\"Coughing\" \/><span class=\"wpcf7-list-item-label\">Coughing<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"Signs-Child[]\" value=\"Shortness of Breath\" \/><span class=\"wpcf7-list-item-label\">Shortness of Breath<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"Signs-Child[]\" value=\"Difficulty Breathing\" \/><span class=\"wpcf7-list-item-label\">Difficulty Breathing<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"Signs-Child[]\" value=\"New loss of taste\" \/><span class=\"wpcf7-list-item-label\">New loss of taste<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"Signs-Child[]\" value=\"New loss of smell\" \/><span class=\"wpcf7-list-item-label\">New loss of smell<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"Signs-Child[]\" value=\"My child does not show any of the above symptoms.\" \/><span class=\"wpcf7-list-item-label\">My child does not show any of the above symptoms.<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><b> Has the child shown signs of any the following symptoms: chills, shivers, muscle aches, headache, sore throat, nausea\/vomiting, diarrhea, fatigue, congestion, or a runny nose? <\/b><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Symptoms-Child2\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"Symptoms-Child2\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"Symptoms-Child2\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><b> Please mark any and all of the symptoms they are experiencing. <\/b><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Signs-Child2\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"Signs-Child2[]\" value=\"Chills\" \/><span class=\"wpcf7-list-item-label\">Chills<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"Signs-Child2[]\" value=\"Shivers\" \/><span class=\"wpcf7-list-item-label\">Shivers<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"Signs-Child2[]\" value=\"Muscle aches\" \/><span class=\"wpcf7-list-item-label\">Muscle aches<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"Signs-Child2[]\" value=\"Headache\" \/><span class=\"wpcf7-list-item-label\">Headache<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"Signs-Child2[]\" value=\"Sore throat\" \/><span class=\"wpcf7-list-item-label\">Sore throat<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"Signs-Child2[]\" value=\"Nausea\" \/><span class=\"wpcf7-list-item-label\">Nausea<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"Signs-Child2[]\" value=\"Vomiting\" \/><span class=\"wpcf7-list-item-label\">Vomiting<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"Signs-Child2[]\" value=\"Diarrhea\" \/><span class=\"wpcf7-list-item-label\">Diarrhea<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"Signs-Child2[]\" value=\"Fatigue\" \/><span class=\"wpcf7-list-item-label\">Fatigue<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"Signs-Child2[]\" value=\"Congestion\" \/><span class=\"wpcf7-list-item-label\">Congestion<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"Signs-Child2[]\" value=\"Runny nose\" \/><span class=\"wpcf7-list-item-label\">Runny nose<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"Signs-Child2[]\" value=\"My child does not show any of the above symptoms.\" \/><span class=\"wpcf7-list-item-label\">My child does not show any of the above symptoms.<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><b> Has anyone in your household shown signs of the following symptoms: Coughing, shortness of breath, difficulty breathing, new loss of taste or smell, chills, shivers, muscle aches, headache, sore throat, nausea, vomiting, diarrhea, fatigue, congestion, or a runny nose? <\/b><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Household-Symptoms\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"Household-Symptoms\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"Household-Symptoms\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><b> Please mark any and all of the symptoms they are experiencing. <\/b><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Signs-Household\"><span class=\"wpcf7-form-control wpcf7-checkbox wpcf7-validates-as-required\"><span class=\"wpcf7-list-item first\"><label><input type=\"checkbox\" name=\"Signs-Household[]\" value=\"Coughing\" \/><span class=\"wpcf7-list-item-label\">Coughing<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"Signs-Household[]\" value=\"Shortness of Breath\" \/><span class=\"wpcf7-list-item-label\">Shortness of Breath<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"Signs-Household[]\" value=\"Difficulty Breathing\" \/><span class=\"wpcf7-list-item-label\">Difficulty Breathing<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"Signs-Household[]\" value=\"New loss of taste\" \/><span class=\"wpcf7-list-item-label\">New loss of taste<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"Signs-Household[]\" value=\"New loss of smell\" \/><span class=\"wpcf7-list-item-label\">New loss of smell<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"Signs-Household[]\" value=\"Chills\" \/><span class=\"wpcf7-list-item-label\">Chills<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"Signs-Household[]\" value=\"Shivers\" \/><span class=\"wpcf7-list-item-label\">Shivers<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"Signs-Household[]\" value=\"Muscle aches\" \/><span class=\"wpcf7-list-item-label\">Muscle aches<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"Signs-Household[]\" value=\"Headache\" \/><span class=\"wpcf7-list-item-label\">Headache<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"Signs-Household[]\" value=\"Sore throat\" \/><span class=\"wpcf7-list-item-label\">Sore throat<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"Signs-Household[]\" value=\"Nausea\" \/><span class=\"wpcf7-list-item-label\">Nausea<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"Signs-Household[]\" value=\"Vomiting\" \/><span class=\"wpcf7-list-item-label\">Vomiting<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"Signs-Household[]\" value=\"Diarrhea\" \/><span class=\"wpcf7-list-item-label\">Diarrhea<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"Signs-Household[]\" value=\"Fatigue\" \/><span class=\"wpcf7-list-item-label\">Fatigue<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"Signs-Household[]\" value=\"Congestion\" \/><span class=\"wpcf7-list-item-label\">Congestion<\/span><\/label><\/span><span class=\"wpcf7-list-item\"><label><input type=\"checkbox\" name=\"Signs-Household[]\" value=\"Runny nose\" \/><span class=\"wpcf7-list-item-label\">Runny nose<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"checkbox\" name=\"Signs-Household[]\" value=\"No one in my household has any of the mentioned symptoms.\" \/><span class=\"wpcf7-list-item-label\">No one in my household has any of the mentioned symptoms.<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><b> Has the child been in contact with someone with COVID-19 or has been within 6 feet for more than 10 minutes in the last 14 days? <\/b><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Covid-Contact\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"Covid-Contact\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"Covid-Contact\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><b> Has the child traveled to an area of high community transmission? <\/b><br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"Travel-History\"><span class=\"wpcf7-form-control wpcf7-radio\"><span class=\"wpcf7-list-item first\"><label><input type=\"radio\" name=\"Travel-History\" value=\"Yes\" \/><span class=\"wpcf7-list-item-label\">Yes<\/span><\/label><\/span><span class=\"wpcf7-list-item last\"><label><input type=\"radio\" name=\"Travel-History\" value=\"No\" \/><span class=\"wpcf7-list-item-label\">No<\/span><\/label><\/span><\/span><\/span>\n<\/p>\n<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Submit\" \/>\n<\/p><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n\n<p><!--?php echo FrmFormsController::get_form_shortcode( array( 'id' =&gt; 2, 'title' =&gt; false, 'description' =&gt; false ) ); 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