COVID-19 Student-Athlete/Coach Self-Screening
This form must be completed every day as part of your at home, self-screening.
If ALL of the BELOW are NO, then the student-athlete/coach may enter the workout area for volunteer summer activities.
If you answer YES to any of the questions, you should stay home, care for yourself and contact your health care provider with worsening symptoms.
What is your Sport/Activity?
Basketball - Boys
Basketball - Girls
Cross Country - Boys/Girls
Dance - Fall
Hockey - Boys
Hockey - Girls
Soccer - Boys
Soccer - Girls
Tennis - Boys
Tennis - Girls
Track and Field
First and Last Name (Do not use nicknames)
Do you have a NEW or WORSENING cough OR shortness of breath?
Do you have at least two of the following symptoms: Fever (>100), chills, muscle pain, headache, sore throat, new loss of taste/smell
Emergency contact name for TODAY:
Emergency contact phone number for TODAY:
A copy of your responses will be emailed to the address you provided.
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This form was created inside of Robbinsdale Area Schools.