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. This is a recommended template for the COVID-19 Questionnaire. Districts can determine the best means (electronic or paper) and platform (Survey Monkey, Microsoft Teams,Google Docs etc.) to administer the questionnaire.
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Student athlete last name *
Student athlete first name *
Parent/Guardian Cell *
Sport *
Has your son/daughter been diagnosed with Coronavirus (COVID-19)? *
If diagnosed with Coronavirus (COVID-19), was your son/daughter symptomatic?
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If diagnosed with Coronavirus (COVID-19), was your son/daughter hospitalized?
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Has any member of the student-athlete’s household been diagnosed withCoronavirus (COVID-19)? *
Signature of Parent/Guardian *
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This form was created inside of MCMSNJ.