Lenape Regional High School District Athletic COVID-19 Questionnaire
In order for student-athletes to participate in workouts during the summer recess period, the parent/guardian must complete this form. This form only needs to be completed one time and must be submitted one week prior to the student-athlete beginning summer workouts. A separate, paper-based symptom checklist will be required to be submitted each day in which the student-athlete is participating in workouts.
* Required
Email address
*
Your email
Student Athletes Name
*
Your answer
Enter Today’s Date
*
MM
/
DD
/
YYYY
Cell Phone # of parent
*
Your answer
Enter Name of the Sport
*
Your answer
Has your son/daughter been diagnosed with Coronavirus (COVID-19)?
*
Yes
No
If diagnosed with Coronavirus (COVID-19), was your son/daughter symptomatic?
*
Yes
No
Not Applicable
If diagnosed with Coronavirus (COVID-19), was your son/daughter hospitalized?
*
Yes
NO
Not applicable
Has any member of the student-athlete’s household been diagnosed with Coronavirus (COVID-19)?
*
Yes
NO
Signature of Parent
*
Your answer
Submit
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