JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Covid 19 Screening- Strive Gymnastics
FORM MUST BE COMPLETED BEFORE EACH CLASS.
IF ANY ANSWERS BELOW ARE YES, PLEASE DO NOT BRING YOUR CHILD TO CLASS.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
*
MM
/
DD
/
YYYY
Childs Name:
*
Your answer
Today or in the past 24 hours, have you or any household members had any of the following symptoms?
Fever (temperature of 100.0°F or above), Chills, Cough,Sore Throat, or Difficulty breathing?
*
Yes
No
Required
Diarrhea, Nausea, Vomiting, Abdominal Pain?
*
Yes
No
Required
Unexplained Rash, Fatigue, Headache? New loss of smell/taste? New muscle aches? Any other signs of illness?
*
Yes
No
Required
In the past 14 days, have you had close contact with a person known to be infected with the novel coronavirus (COVID-19)?
*
Yes
No
Required
Signature:
*
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
