Athletics Self-Screen

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This form must be completed prior to participation, daily. If you have any questions, please contact the Athletic Training staff at (407) 206-1900 x.1218.
**Any student with a pre-existing condition please notify your coach to take extra precautions**

Email *

Full Legal Name *

Date *

YYYY

Sport *

Swim

Tennis

Other:

Have you been diagnosed with COVID-19? *

Yes

Have you or a family member been exposed to COVID-19? *

Yes

Have you experienced a fever within the last 48 hours? *

Yes

Have you travelled to any "hot-spot" within Florida or travelled outside of the state within the last 14 days? *

Yes

I do not have a temperature of greater than 100 degrees and have checked my temperature prior to participation at Lake Highland Preparatory School. *

By checking this box, I affirm that the above statement is true.

Required

Are you experiencing any of the following symptoms? *

Shortness of breath or difficulty breathing

Cough

Sore throat

Runny nose or nasal congestion

GI symptoms (nausea, vomiting, or diarrhea)

Loss of sense of smell or taste

Disequilibrium (dizziness)

Chills

Headache

Not experiencing any of the above symptoms.

Required

Important Reminders

Send me a copy of my responses.

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