Dudley Middle School Athletics 2020-2021 Spring Sports Attestation Form
*This form is to be completed and submitted by a parent/guardian*

Dear Parent/Guardian:

Due to the high risk nature of many of the Spring sports being offered this year, parents/guardians are asked to sign off on the following acknowledgment. No student-athlete will be allowed to participate in the following Spring sports unless this form is submitted. Thank you for your understanding and cooperation.
Student-Athlete's Last Name *
Please enter your student-athlete's last name.
Student-Athlete's First Name *
Please enter your student-athlete's first name.
Student-Athlete's Grade *
Please select your student-athlete's current grade level.
Parent/Guardian Last Name *
Please enter your (parent/guardian) last name.
Parent/Guardian First Name *
Please enter your (parent/guardian) first name.
Email Address *
Please enter your (parent/guardian) email address.
What Spring sport is your student-athlete registered to participate in? *
COVID-19 Certification (please read and acknowledge) *
Required
COVID-19 Symptoms
- Fever (100° Fahrenheit or higher), chills, or shaking chills
- Cough (not due to other known cause, such as chronic cough)
- Difficulty breathing or shortness of breath
- New loss of taste or smell
- Sore throat
- Headache, when in combination with other symptoms
- Muscle aches or body aches (not related to athletic activity)
- Nausea, vomiting, or diarrhea
- Fatigue, when in combination with other symptoms
- Nasal congestion or runny nose (not due to other known causes, such as allergies), when in
combination with other symptoms
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