Student-Athlete & Staff Pre-Participation COVID-19 Screening Questionnaire
Please respond to the questions below related to COVID-19 exposure or symptoms.

If you answer YES to any question, DO NOT participate in any activities.

For WEST students, immediately contact Jordan.Napoli@nbexcellence.org at 262-789-6409 for further instructions.

Any individual (staff or student) who answers yes to any symptom listed below will not be allowed to take part in workouts and should contact his or her primary care provider or other appropriate health- care professional.

Any athlete, coach, or staff member living with someone who experiences any of the symptoms of COVID-19, whether they have a positive COVID-19 test or not, should contact the school AD (see contact info above).
Full Name of Student-Athlete (or Staff Member) *
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