JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
COVID-19 Questionnaire
To participate in workouts during the summer recess period, the parent/guardian must complete this form. This form only needs to be completed one time.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Name of Student:
*
Your answer
Date
*
MM
/
DD
/
YYYY
Parent/Guardian Cell Phone Number:
*
Your answer
Sport
*
Your answer
Has your son/daughter been diagnosed with Coronavirus (COVID-19)?
*
1 point
Yes
No
If diagnosed with Coronavirus (COVID-19), was your son/daughter symptomatic?
*
1 point
Yes
No
If diagnosed with Coronavirus (COVID-19), was your son/daughter hospitalized?
*
1 point
Yes
No
Has any member of the student-athlete’s household been diagnosed with Coronavirus (COVID-19)?
*
1 point
Yes
No
Signature of Parent/Guardian (you can print)
*
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Keyport School District.
Report Abuse
Forms
