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.
Email address *
Name of Student: *
Date *
MM
/
DD
/
YYYY
Parent/Guardian Cell Phone Number: *
Sport *
Has your son/daughter been diagnosed with Coronavirus (COVID-19)? *
1 point
If diagnosed with Coronavirus (COVID-19), was your son/daughter symptomatic? *
1 point
If diagnosed with Coronavirus (COVID-19), was your son/daughter hospitalized? *
1 point
Has any member of the student-athlete’s household been diagnosed with Coronavirus (COVID-19)? *
1 point
Signature of Parent/Guardian (you can print) *
Submit
Never submit passwords through Google Forms.
This form was created inside of Keyport School District. Report Abuse