Cumberland Valley Marching Band Student & Staff COVID-19 Screening Questionnaire
This questionnaire must be completed by instructors and parents/guardians prior to each rehearsal, whether that rehearsal is of just a section of the band or the entire ensemble.
PARENTS WITH MULTIPLE STUDENTS must complete a questionnaire for EACH of their children for EVERY sectional/rehearsal.
This is a requirement of CVSD and is not negotiable.
Questionnaire must be completed ON THE DAY of a given sectional/rehearsal.
Students whose parent/guardian does not complete this questionnaire by 15 minutes prior to rehearsal will not be permitted to participate and will be required to leave campus.
Student's Section of the Band
Front Ensemble Percussion
Student/Staff Last Name
Student/Staff First Name
Grade for 2020-21 SY
Please input your student's temperature that was taken sometime TODAY.
Please select any symptoms that apply to your student TODAY. Please KEEP YOUR STUDENT HOME if ANY of these symptoms exist. This entry will serve as your student's "excuse" from rehearsal if necessary.
Fever or Chills
Shortness of breath
Loss of taste/smell
Within the past 14 days, has your student had close contact with someone who is currently sick with suspected or confirmed COVID-19? (Note: Close contact is defined as within 6 feet for more than 10 consecutive minutes, without PPE equipment.) If your response is “YES”, student will NOT be allowed to rehearse or perform, and will be asked to leave school grounds. Parent/Guardian will be notified. NOTE: THIS IS NOT PUNITIVE. This is for everyone's health & safety, including staff and all other students.
PARENT/GUARDIAN: By typing your name you are indicating you have discussed your student's(s') symptoms with them, and that your responses are truthful.
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This form was created inside of Cumberland Valley School District.