AHS Marching Band COVID-19 Health Screening
This form is REQUIRED and must be submitted 3 hours prior to every rehearsal by ALL students and staff.

IF YOU FAIL THIS SCREENING ,YOU CAN NOT PARTICIPATE and should STAY HOME and call Mr. Keech at 845-288-2675.

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1. Have you experienced any symptoms of COVID-19, including a temperature of greater than 100.0°F, chills, cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, headache, new loss of taste or smell, sore throat, congestion or runny nose, nausea or vomiting or diarrhea in the past 10 days?

2. Within the past 14 days, have you been in close physical contact (6 feet or closer for at least 10 minutes) with a person who is known to have laboratory-confirmed positive COVID-19 test or with anyone who has any symptoms consistent with COVID-19?

3. Have you tested positive through a diagnostic test for COVID-19 in the past 10 days or are you waiting for results from a COVID-19 test?

4. Have you traveled internationally or from a state with widespread community transmission of COVID-19 per the New York State Travel Advisory in the past 14 days?

Click here for a list of states with widespread community transmission:
https://coronavirus.health.ny.gov/covid-19-travel-advisory
Email address *
First Name *
Last Name *
What is TODAY's Date? mm/dd/yyyy *
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If your answer to all the questions above is NO, please click PASS SCREENING below. If your answer to any of the questions above is YES, please click FAIL SCREENING below and contact Mr. Keech and Mr. Rzodkiewicz via email immediately. *
A copy of your responses will be emailed to the address you provided.
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