Statesboro STEAM Academy Student Health Report Form

Student Last Name *

Student First Name *

Age *

Parent's Name *

Telephone *

Email *

Has this student tested positive for Covid-19 within the past week? *

Yes

No

Are you reporting an illness that may not be related to Covid-19? *

Yes

No

Does this student have any of the following symptoms associated with Covid-19? *

Will the student be tested for Covid-19? *

Yes

No

What was the date of the first known symptoms? * +

Form Completer *

Date of Submission * +

NOTICE OF NONDISCRIMINATORY POLICY Statesboro STEAM Academy admits students of any race, color, national and ethnic origin to all the rights, privileges, programs, and activities generally made available to the students of the school. Statesboro STEAM Academy does not discriminate on the basis of race, color, national or ethnic origin in administration of its educational policies, admissions policies, nor any other school-administered programs.