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 *
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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