Spectator Clearance Form: GVHS SPRING CONCERT 5-24-21
GVHS Music Department Spring Concert
Mon, 5-24-21 (rain date 5-26)
6:30pm
GVHS Stadium

Students in 9th, 10th, and 11th grade may have TWO guests.
Seniors (12th grade) may have up to FOUR guests.
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Your name (name of guest) *
Your email address *
Performer (student) First Name *
Performer (student) Last Name *
In the past 72 hours, do you have ONE or more of symptoms from Group A or TWO or more symptoms from Group B? (Chester County Health Department Symptom Assessment):   Group A: Lack of Smell or Taste (without congestion), Cough, Shortness of Breath, Difficulty Breathing.     Group B:  Fever (oral > 100.4, axillary/temporal > 99.5), Sore Throat, Chills, Muscle Pain, Fatigue, Headache, Congestion or runny nose, Nausea or vomiting, Diarrhea? *
In the past 72 hours, has anyone in your household had symptoms listed in Group A (one or more symptoms) or Group B (two or more symptoms): Group A:  Lack of Smell or Taste (without congestion), Cough, Shortness of Breath, Difficulty Breathing.     Group B:  Fever (oral > 100.4, axillary/temporal > 99.5), Sore Throat, Chills, Muscle Pain, Fatigue, Headache, Congestion or runny nose, Nausea or vomiting, Diarrhea? *
In the past 14 days, have you had close contact (as defined by the CDC) with anyone who has tested positive for COVID-19, is in the process of being tested for COVID-19, is isolating as a result of a suspected COVID-19 infection, or is experiencing acute symptoms of COVID-19? *
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