Mobile Check In
Please use this form to check in to special events, sporting events, and co-op on your phone or other device. Only your last name and number of people with you are required in addition to the symptom/exposure questions. If you can not answer "yes" to the questions below, you will not be able to attend for that day.
Thank you you for your cooperation and understanding in this matter.
Sign in to Google to save your progress. Learn more
First Name
Last Name *
Total number of people attending in your family (including you) *
Their names
Please confirm the following: 1.) I have taken the temperature of all persons with me today and no one has a fever of 100 degrees or higher, I have not given anyone medication to lower a fever. *
Required
Please confirm the following: 2.) No one has had a fever of 100 degrees or higher in my home for the last 3 days - to my knowledge *
Required
Please confirm the following: 3.) No one in my home has symptoms of Covid 19 (Current COVID-19 symptoms include cough, fever of 100.0 or higher, chills, muscle pain, shortness of breath or difficulty breathing, sore throat, a new loss of taste or smell, gastrointestinal symptoms like nausea, vomiting, or diarrhea.) *
Required
Please confirm the following: 4.) To my knowledge no one in my home or with me today has been exposed to a person suspected of having Covid 19 in the last 14 days *
Required
Please confirm the following: 5.)No member of my family is under voluntary quarantine or isolation order. *
Required
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Excellence in Learning Cooperative. Report Abuse