COVID Athlete Screening Form
If any responses are "YES", student will NOT be permitted to practice or compete, and will be asked to leave school grounds.  Any student with a temperature reading of 100.4 degrees or higher is also not permitted to attend.  Parent/Guardian will be notified.
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Student Athlete First Name *
Student Athlete Last Name *
Today's Date *
MM
/
DD
/
YYYY
Do you have any of the following symptoms? *
YES
NO
Fever / Chills
Cough
Sore Throat
Shortness of Breath
Loss of Taste/Smell
Vomitting / Diarrhea
Within the past 14 days, have you 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.) *
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