Summer Waiver Period Health Survey

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Last Name *

First Name *

Grade *

Activity *

Speed and Strength

Football

Volleyball

Basketball

Baseball

Softball

Track

Cross Country

You are required to check your temperature at home before participating. Was your temperature in the normal range? *

Yes

Have you been diagnosed with COVID-19 at any time? *

Yes

Do you currently feel sick? *

Yes

Have you had any of the following symptoms in the last week?

Fever

Extreme Level of Fatigue

Cough

Pain/Difficulty Breathing/Shortness of Breath

Sore Throat

Body Muscles/Aches

Loss of Taste/Smell

Eye Discharge/Vision Issues

If you answered yes to any of the symptoms above, please explain.

Have you been out of the country this calendar year? *

Yes

In the past 14 days, have you experienced suspected exposure to COVID-19? *

Yes

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