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Pre-Rehearsal Health Check
Please fill out this form PRIOR to arriving to the school. It must be filled out for every event, on the day of the event, and must be filled out by anyone entering the building (students, parents, staff, etc.).
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Email Address
*
Your answer
Participant's Last Name
*
Your answer
Participant's First Name
*
Your answer
Today's Date
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MM
/
DD
/
YYYY
I, the undersigned, will answer the following questions, from all sections, truthfully and to the best of my knowledge. By signing, I also recognize the expectation of wearing a facial covering and maintaining social distancing by keeping a six-foot radius between myself and others. (Please enter your first and last name in the text field below)
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Your answer
Have you come in close contact with anyone in the last 14 days with a diagnosis of COVID-19? (IF YOU ANSWERED YES, DO NOT REPORT TO PRACTICE)
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Yes
No
Have you experienced a fever of at least 100.3 or higher in the last 72 hours? (IF YOU ANSWERED YES, DO NOT REPORT TO PRACTICE)
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Yes
No
Have you experienced a cough (excluding chronic cough) in the last 72 hours? (IF YOU ANSWERED YES, DO NOT REPORT TO PRACTICE)
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Yes
No
Have you experienced shortness of breath in the last 72 hours? (IF YOU ANSWERED YES, DO NOT REPORT TO PRACTICE)
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Yes
No
Have you experienced a sore throat in the last 72 hours? (IF YOU ANSWERED YES, DO NOT REPORT TO PRACTICE)
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Yes
No
What is your current temperature? (If your temperature is above 100.3 do not attend practice) Your temperature will also be taken upon arrival at practice.
*
Your answer
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