Student COVID-19 Self Certification Form for January ’22 – Due by January 4th
December 30, 2021

This is the January version of the self-certification form and needs to be filled out by a parent or guardian before students return on January 4th.  Instead of the daily form that was used last year, we are filling out these forms monthly throughout the school year.  A form needs to be filled out for each student, and please make sure to select the form for the correct school.

Worth Elementary Self-Certification Form for January

Worthwoods Elementary Self-Certification Form for January

Worth Junior High Self-Certification Form for January