Pre-Activity Form
Please read this document carefully as it may affect your ability to gain access to our schools and facilities.

The safety of our students and staff at LCPS facilities remains our top priority. As a result of the Novel Coronavirus (COVID-19) outbreak, which continues to evolve, we are implementing certain protocols to safeguard all visitors to LCPS buildings and campuses.

As part of our ongoing community care efforts, we are asking all visitors to read this health declaration silently to themselves and answer honestly before entering any LCPS facility or participating in any out of season practice.

If you answer “yes” to any of the questions below, you may not enter our building.

Please be sure to bring your own MASK, LABELED WATER BOTTLE, HAND SANITIZER, and OTHER EQUIPMENT. Items MAY NOT be shared among athletes for your safety.

Athletes MUST maintain a minimum distance of 10 feet between each other at all times.

Answer “YES” or “NO”, in the last fourteen (14) days, have you had any of the following:

Name - First & Last *
Temperature at Arrival to Practice
DO NOT ANSWER - (This will be filled in by coach at practice)
A new fever (100.0°F or higher) or a sense of having a fever? *
2. A new cough that you cannot attribute to another health condition? *
3. New shortness of breath that you cannot attribute to another health condition? *
4. A new sore throat that you cannot attribute to another health condition? *
5. New muscle aches (myalgia) that you cannot attribute to another health conditionor that may have been caused by a specific activity (such as physical exercise)? *
6. Have you been around someone who has symptoms of illness or someone who has tested positive for COVID-19? *
I acknowledge that I have answered these questions to the best of my ability. I understand that if I show signs or symptoms of potential respiratory illness, or if I have a fever that I will be required to return home and may not stay on LCPS campus.
Please type your full name which will serve as your Electronic Signature.
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