ATHLETIC WORKOUTS COVID-19 Screener

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Students participating in Strength and Conditioning Workouts and Sports Specific Workouts should complete this form. All students or parents must complete the screener weekly to attend workouts. If at any time during the week a student athlete experiences any of the symptoms below, please stay home and contact a Coach or administration immediately. You may complete one form per family.

Date: *

YYYY

Last Name of Student(s) *

First Name of Student(s) *

Do any of the following health conditions apply to the student or his/her siblings attending workouts? *

Cough

Shortness of breath/difficulty breathing

chills or repeated shaking with chills

headache or muscle pain

sore throat

loss of sense of smell or taste

diarrhea

feeling feverish or a fever of 100+ degrees

have had close contact with a person who is CONFIRMED to have COVID-19 within the last 14 days

None of these apply

Required

By submitting this form, I confirm that all the information presented is factual and true. *

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