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COVID-19 Daily Pre-screening Questions
To participate in WDMB rehearsals during the summer recess period each student must complete this form prior to every rehearsal. Screening questionnaires must be completed prior to arriving on school grounds.
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* Indicates required question
Student's Name
*
Last name, First name
Your answer
Today's Date
*
MM
/
DD
/
YYYY
Parent/Guardian's Name
*
Your answer
Parent/Guardian Cell Phone Number
*
Your answer
Are you experiencing a fever >100.4 today?
*
Yes
No
Are you experiencing Cough or shortness of breath?
*
Yes
No
Are you experiencing Sore Throat?
*
Yes
No
Are you experiencing Chills?
*
Yes
No
Are you experiencing Muscle aches or rigors?
*
Yes
No
Are you experiencing Headache?
*
Yes
No
Are you experiencing New loss of taste or smell?
*
Yes
No
Are you experiencing Abdominal pain, nausea, vomiting or diarrhea?
*
Yes
No
Have you had close contact with someone who is currently sick?
*
Yes
No
Have you been diagnosed with COVID-19 in the past three weeks or have reason to believe you have COVID-19?
*
Yes
No
Have you traveled or had close contact with anyone who has traveled internationally in the last 14 days?
*
Yes
No
If you took your temperature this morning, what was the reading?
*
Your answer
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