Keyport Public Schools COVID: Athletic Symptom Parent Verification Form
Any of the symptoms below could indicate a COVID-19 infection in children and may put your child at risk for spreading illness to others. Please note that this list does not include all possible symptoms and children with COVID-19 may experience any, all, or none of these symptoms. Please check your child daily for these symptoms.
Section A - If TWO OR MORE of the fields in this section are checked off, please keep your child home and notify the school for further instructions. This includes keeping your child home from after school athletic activity as well.
Fever (measured of subjective)
Myalgia (muscle aches)
Nausea or Vomiting
Congestion or runny nose
Section B - If AT LEAST ONE field in this section is checked off, please keep your child home and notify the school for further instructions
Shortness of Breath
New loss of smell
New loss of taste
If ANY of the fields in the 'Close Contact/Potential Exposure' section below are checked off, your child should remain home for 14 days from the last date of exposure (if child is a close contact of a confirmed COVID-19 case) or date of return to New Jersey.
Contact your child’s provider or your local health department for further guidance.
Please verify if:
Your child has had close contact (within 6 feet of an infected person for at least 10 minutes) with a person with confirmed COVID-19
Someone in your household is diagnosed with COVID-19
Your child has traveled to an area of high community transmission.
Verification: Select 'Yes' in the dropdown to verify that all information on this form is correct to the best of your knowledge
Please provide the student-athlete's name below:
Please provide the parent/guardian's signature below:
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This form was created inside of Keyport School District.