Daily Health Form
As part of our approved plans for middle school athletics, this survey will be distributed daily to monitor the health of our student-athletes. Parents/Guardians should complete the screening each day for their child(ren) prior to reporting to their scheduled practice or game. Results will be accessible daily by coaches, athletic trainers, and athletic directors for review prior to allowing athletes/staff members to participate. Coaches will also take attendance at all practices.

** SURVEY NEEDS TO BE COMPLETED DAILY by 1:00 pm. If your answer is "Yes" to any question 7-10, or if your child's temperature is 100.4 or higher, please keep them home! They will not be permitted at practice.
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Email *
1. Today's Date (MM/DD/YY) *
MM
/
DD
/
YYYY
3. Student Last Name *
2. Student First Name *
4. Grade *
5. School *
6. Sport *
7. In the past 72 hours, have you or anyone in your household experienced any of the following symptoms related to COVID-19. *
Required
8. In the past 14 days, have you had close contact with anyone who tested positive for COVID-19, is in the process of being tested for COVID-19, is isolating as a result of suspected COVID-19 infection, or is experiencing acute symptoms of COVID-19? *
9. Have you or anyone in your household traveled to one of the states listed below in the past 14 days? Alabama,Arkansas,Florida,Georgia,Idaho,Illinois,Iowa,Kansas,Kentucky,Mississippi,Missouri,Nebraska,North Dakota,Oklahoma,South Carolina,South Dakota,Tennessee,Texas,Utah,Wisconsin *
10. Has family coming from one of these states stayed in your residence in the past 14 days? *
Student temperature today: (If 100.4 or higher, please stay home). *
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