COVID-19 Screening Questionnaire
Each daily screening questionnaire must be filled out by a parent/guardian.Please provide a parent/guardian's valid email address! To participate in workouts during the summer recess period, each student and their parent/guardian must complete this form daily before every workout. Screening questionnaires must be completed prior to arriving on school grounds.
Email address *
Name of Student *
Today's Date *
Parent/Guardian's Cell Phone Number *
Sport *
Are you experiencing any of the following symptoms? Please click "yes" or "no".
Fever (> 100.4 degrees Fahrenheit) *
Cough or Shortness of Breath *
Sore Throat *
Chills *
Muscle aches or rigors *
Headache *
New loss of taste or smell *
Abdominal pain, nausea, vomiting or diarrhea *
Have you had close contact with someone who is currently sick? *
Have you been diagnosed with COVID-19 in the past three weeks or have reason to believe you have COVID-19? *
Have you traveled or had close contact with anyone who has traveled internationally in the last 14 days? *
If you took your temperature this morning, what was the reading? If you did not take your temperature, please put in N/A. The Athletic Trainer will take your temperature upon arrival to your workout. *
Does the athlete have any pre-existing medical conditions and/or are immunocompromised (e.g., diabetes, asthma, auto-immune disorders, etc.)? *
If you chose "yes", please explain below:
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