COVID-19 STUDENT ATHLETE SELF-SCREENING QUESTIONNAIRE
In an effort to reduce the risk of COVID-19 exposure, all Clarkston Schools student athletes present on school grounds must complete the following daily screening questions.

An answer of “Yes” to any of these questions or if you have a temperture greater than 100.4 will exclude you from school grounds and contact Jeff Kosin, Shane Kerbelis or Kellie George immediately.

Screening checklist
https://www.oakgov.com/covid/supplements/!Compliance%20Toolkit%20-%20Health%20Order%2007.pdf

Symptoms of Coronavirus
https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html
Email address *
FIRST NAME *
LAST NAME *
What sport will be practicing? *
Date In the CCS Facility *
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Do you have any of the following symptoms: fever/feverish, chills, sore throat, dry cough, difficulty breathing, or digestive symptoms such as diarrhea, vomiting, and abdominal pain? *
In the past 14 days, have you been within 6 feet for 15 minutes with a person diagnosed with COVID-19? *
In the past 14 days, have you travelled internationally or outside the state of Michigan? *
A copy of your responses will be emailed to the address you provided.
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