Bus Transportation Requests -

Health Screening

Mandatory Health Screening Questions

for Students, Staff, Vendors

Hidden
admin
Hidden
User Role
Hidden
Household
Hidden
Name*
First Last
Email
Hidden
Date
MM slash DD slash YYYY
Login to the Portal to access the rest of this form
Health screening for…*
- Staff
- Student
- Vendor/Guest
Hidden
Which Grades will you be in contact with?*
- None
- Nursery 2s
- Nursery 3s
- PreK
- Kindergarten
- Kindergarten
- 1st Grade
- 2nd Grade
- 3rd Grade
- 4th Grade
- 5th Grade
- 6th Grade
- 7th Grade
- 8th Grade
- Other
Select Student*
Hidden
Student ID
Hidden
Student Grade
Hidden
Student Name Full
Hidden
Student Name
First Last
Hidden
Status
Company if Vendor | Grade if Substitute
Vendor or Guest Name
First Last
Vendor or Guest Email
Birthday
In the past 10 days, this individual has been tested for the virus that causes COVID-19, also known as SARS-CoV-2?*
- No
- Yes
Was the test result positive OR are you still waiting for the result?*
- No
- Yes
Hidden
In the last 10 days has this individual traveled to a NONCONTIGUOUS state?*
- No
- Yes
Hidden
How long was your visit*
- Less than 24 hours
- More than 24 hours
Hidden
Have you received a Negative Covid-19 test in the four (4) days since returning to NY?*
- Yes
- No
Hidden
Have you received a Negative Covid-19 test within three (3) days prior to your return to NY?*
- Yes
- No
Hidden
Did you quarantine for 3 days upon returning?*
- Yes
- No
Hidden
Did you receive a negative test on day 4 of your return?*
- Yes
- No
In the last 14 days, has this individual been designated in contact of a person who tested positive for COVID-19 by a local health department?*
- No
- Yes
Does this individual currently have (or has had in the last 10 days) one or more of these new or worsening symptoms?*
- A temperature
  greater than or
  equal to 100.0° F
- Feel feverish
  or have chills
- Cough
- Loss of taste
  or smell
- Fatigue/feeling
  of tiredness
- Sore throat
- Shortness of breath
  or trouble breathing
- Nausea, vomiting, diarrhea
- Muscle pain
  or body aches
- Headaches
- Nasal congestion/runny nose
- No Symptoms
Hidden
Symptom Total
Hidden
In School Temperature Check
- Not taken
- Normal
- Has Temperature

Today is Tuesday
Jun 28, 2022

Visit our Covid-19 Dashboard

login
- Login Help
Visit the Main High Meadow Site

Menu

login
- Login Help
Visit the Main High Meadow Site

Logout

Email Address

Password

Remember Me

Lost your password?

-- OR -- Login using your gmail account below ---

Connect with

Login with Google

1) Re-enrollment Contract
2) Family Registration
3) Health Form
4) Media Release
5) Communications Form
6) Add Skills Form
7) School District
8) COVID-19 Community Pledge
10) Bus Transportation Requests (optional)

Menu

1) Re-enrollment Contract
2) Family Registration
3) Health Form
4) Media Release
5) Communications Form
6) Add Skills Form
7) School District
8) COVID-19 Community Pledge
10) Bus Transportation Requests (optional)

2022/23 Bus Request form

You must fill out a separate form for each student.
Hidden
Household
Hidden
School Year
- 2022/2023
- 2021/2022
- 2020/2021
- 2019/2020
School District*
Email*
Date
MM slash DD slash YYYY
Student Name*
Hidden
Student Name*
First Last
Hidden
Student ID
Street Address*
Street Address Address Line 2 City State ZIP Code
Mailing Address
Same as previous

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Student Age*
Date of birth*
MM slash DD slash YYYY
Grade Level in September 2021*
School requesting Transportation to*
School attended by your child in the 2022/2023 School year*
Student Ethnicity (choose one):
- I – American Indian or Native America
- W – White
- B – Black or African American
- P – Native American or other Pacific Islander
- H – Hispanic or Latino
- A – Asian
Student lives with
- Both Parents
- Father
- Mother
- Legal Guardian
- Step‐Parent
Parent/Guardian Name*
First Last
Parent/Guardian Relation to Student
Parent/Guardian Home Phone*
Parent/Guardian Cell Phone*
Parent/Guardian Name 2 (if applicable)
First Last
Parent/Guardian 2 Home Phone
Parent/Guardian 2 Cell Phone
Signature of Parent/Guardian*
Emergency Contacts (Provide at least 2)*
Click "+" to add additional contact(s)
Emergency Contact Name Emergency Contact Phone Emergency Contact Address Relation to Student
CAPTCHA

Emergency Contact Name	Emergency Contact Phone	Emergency Contact Address	Relation to Student

Mandatory Health Screening Questions

Today is TuesdayJun 28, 2022

-- OR -- Login using your gmail account below ---

2022/23 Bus Request form

You must fill out a separate form for each student.

Today is Tuesday
Jun 28, 2022