Self Screen for Athletic Participation

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Email *

Participant Name *

Student Sport *

Alumni

Faculty/Staff/Guest

Basketball

Cross country

Fitness

Field hockey

Golf

Lacrosse

Rowing

Soccer

Softball

Swim & Dive

Tennis

Track & Field

Volleyball

Do you currently have, or within the last 24 hours had, a temperature of 99.9 or greater? *

Yes

In the last 48 hours, have you had any of the following NEW symptoms? *

Cough

Trouble breathing, shortness of breath or severe wheezing

Chills or repeated shaking with chills

Sore throat

Loss of smell or taste, or a change in taste

Nausea, vomiting or diarrhea

None of the above

Required

Have you had close contact in the last 14 days with an individual diagnosed with COVID-19? *

Yes

Have you traveled on to a COVID hotspot in the last 14 days? Per Ohio Governor DeWine’s guidelines from July 22, 2020, if your child has traveled to a state that has a COVID testing positivity rate of 15% or more, you are required to notify the School and keep your child home for 14 days upon your return to Ohio. Current COVID hotspots are: Alabama, Arizona, Florida, Idaho, Mississippi, Nevada and Puerto Rico. *

Yes

I have answered the above questions honestly and am currently in good health. *

I agree

A copy of your responses will be emailed to the address you provided.

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