2020 Carroll Charger Pride Covid-19 Daily Pre-Screen Form
Email address *
Today's Date *
MM
/
DD
/
YYYY
Student LAST Name
Student FIRST Name
Adult LAST Name
Only complete this is you are attending a Charger Pride rehearsal in the capacity of a parent volunteer or staff member.
Adult FIRST Name
Only complete this is you are attending a Charger Pride rehearsal in the capacity of a parent volunteer or staff member.
Student Grade *
Grade during 2020-2021 Academic Year
Instrument/Section *
Do you have a persistent cough? *
If yes, please contact both Mr. Hassell and Mr. Frazier prior to attending rehearsal. (doug.hassell@nacs.k12.in.us; phillip.frazier@nacs.k12.in.us)
Do you have shortness of breath or find it hard to breathe? *
If yes, please contact both Mr. Hassell and Mr. Frazier prior to attending rehearsal. (doug.hassell@nacs.k12.in.us; phillip.frazier@nacs.k12.in.us)
Do you have a fever of 100 degrees or higher? *
If yes, please contact both Mr. Hassell and Mr. Frazier prior to attending rehearsal. (doug.hassell@nacs.k12.in.us; phillip.frazier@nacs.k12.in.us)
Do you have a sore throat? *
If yes, please contact both Mr. Hassell and Mr. Frazier prior to attending rehearsal. (doug.hassell@nacs.k12.in.us; phillip.frazier@nacs.k12.in.us)
Have you experienced a new or recent loss of taste or smell? *
If yes, please contact both Mr. Hassell and Mr. Frazier prior to attending rehearsal. (doug.hassell@nacs.k12.in.us; phillip.frazier@nacs.k12.in.us)
Are you caring for someone who is ill? *
If yes, please contact both Mr. Hassell and Mr. Frazier prior to attending rehearsal. (doug.hassell@nacs.k12.in.us; phillip.frazier@nacs.k12.in.us)
Within the last 2 weeks have you lived with, cared for or had close contact with someone diagnosed with COVID-19? *
If yes, please contact both Mr. Hassell and Mr. Frazier prior to attending rehearsal. (doug.hassell@nacs.k12.in.us; phillip.frazier@nacs.k12.in.us)
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of Northwest Allen County Schools. Report Abuse