BDHS Athletics COVID-19 SELF ASSESSMENT FORM
Please fill this out within 24 hours of your return to Athletics for your first practice or after an extended break.
Email address *
Today's Date: *
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Student's Name: *
Parent/Guardian's Name: *
Sport: *
Have you had a temperature of over 100.4℉ in the last 24 hours? *
Have you had any of the following symptoms in the last 24 hours? If not, answer "No". *
Required
Have you traveled outside of the country within the past 14 days? *
Have you been in close contact with anyone known or suspected to have the COVID-19 coronavirus illness in the last 14 days? *
I CERTIFY THAT THE ABOVE ANSWERS ARE TRUE, ACCURATE, AND COMPLETE. I ALSO CERTIFY THAT IF AT ANY POINT, I CAN ANSWER YES TO ANY OF THE ABOVE QUESTIONS, I WILL IMMEDIATELY NOTIFY A COACH OR ADMINISTRATOR AND WILL STAY HOME UNTIL I CAN ANSWER NO TO ALL OF THE ABOVE QUESTIONS. I acknowledge the above *
A copy of your responses will be emailed to the address you provided.
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