Daily Fall Pre-Practice COVID-19 Symptom Form
Please complete this form each day of practice prior to 1:00 PM. Please complete the night before for our Saturday rehearsals and football games.
Email address *
First Name of Student
Last Name of Student
Date
MM
/
DD
/
YYYY
Are you experiencing any of the following syptoms (Fever (> or = to 100.4 F, 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)?
Clear selection
If "Yes", please list the symptoms experienced. If "No symptoms", please write "No".
Have you had close contact with someone is currently sick?
Clear selection
Have you been diagnosed with COVID-19 in the past three weeks or have reason to believe you have COVID-19?
Clear selection
Have you traveled or had close contact with anyone who has traveled internationally in the last 14 days?
Clear selection
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of Verona Public Schools. Report Abuse