Stevenson Band: COVID-19 Sectional Monitoring Self-Report
Participants must submit this form prior to participating at every (and just prior to) all sectionals in 2020. IMPORTANT: This form will need to be completed multiple times by everyone this summer - once each day the student attends a sectional.

Please note that participants will have their temperature taken when they arrive for their sectional.

Participants with positive symptoms reported shall not be allowed to participate and should contact their primary care provider or other appropriate health-care professional.
Email address *
Participant Name (First and Last) *
Participant's Section: *
Parent Name (First and Last, if participant is a student) *
Does the participant have a fever today? *
Does the participant have a cough? *
Does the participant have a sore throat? *
Does the participant have shortness of breath? *
Has the participant cared for, or had close contact with, someone that has tested positive for COVID-19 in the past 14 days? *
I certify that the above questions have been answered truthfully to the best of my knowledge. *
A copy of your responses will be emailed to the address you provided.
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy