Girls Track Health Form

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Full First and Last Name *

Grade *

Level

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Are you/were you in close contact with someone currently diagnosed with COVID-19 within the past 10 days? *

Yes

Have you tested positive for COVID-19 within the past 10 days? *

Yes

Have you or a family member traveled from a state on the current "New York Travel Advisory List" or internationally within the past 10 days? *

Yes

Are you currently (or within the past 24 hours) experiencing any of the following symptoms? *

Fever

Difficulty Breathing

Chills

Unusually Weak/fatigued

repeated shaking/shivering

loss of taste or smell

cough

muscle aches or pain

sore throat

runny/congested nose

shortness of breath

diarrhea

None of the Above

Required

My Temperature is: *

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