Student-Athlete & Coach Pre-Participation COVID-19 Screening Questionnaire

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Please respond to the questions below related to COVID-19 exposure or symptoms.

If you answer YES to any question, DO NOT participate in any activities.

For students, immediately contact Assistant AD Nick Conrad, conradn@cudahysd.org or 414-294-2712 for further instructions.

Any individual (staff or student) who answers yes to any symptom listed below will not be allowed to take part in workouts and should contact his or her primary care provider or other appropriate health- care professional.

Any athlete, coach, or staff member living with someone who experiences any of the symptoms of COVID-19, whether they have a positive COVID-19 test or not, should contact the school AD (see contact info above).

Full Name of Student-Athlete (or Coach) *

Sport That You Are Attending the Workout For *

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