CCSD Athletics COVID Attestation 2023

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Email *

Name of Parent/Guardian Completing Form *

Student First Name *

Student Last Name *

School *

Grade Level *

Sport & Level *

Attestation

Please complete the attestation below. If you cannot answer NO to all of the questions, please contact your child’s school nurse. Your child will need to be cleared by a physician to return to play.

Robert E. Bell:

Christina Ahern 238-7202 x3104 (fax: 914-817-0215)

Seven Bridges:

Rebecca Sotherden 238-7203 x4104 (fax: 914-817-0177)

Horace Greeley:

Ellen Caruso 238-7201 x2133

Did the student have any of the following during COVID? *

Chest pain or palpitations

Prolonged high fever (Temp>103F for 3 days or longer)

Symptoms requiring an ER visit or hospitalization

Please Initial: I attest that my child did not have these issues during COVID: Chest pain or palpitations; Prolonged high fever (Temp>103F for 3 days or longer); and Symptoms requiring an ER visit or hospitalization.

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