JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Huron Bands - COVID 19 - Summer Rehearsal Pre-Screening
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Student Last Name
*
Your answer
Student First Name
*
Your answer
Date of the Rehearsal (NOT YOUR BIRTHDAY)
*
MM
/
DD
/
YYYY
Type of Band Rehearsal
*
Choose
Drum Major Candidate Practice
Drumline Practice
Colorguard Practice
Full Band Rehearsal
Student's Temperature (degrees Fahrenheit)
*
Your answer
Has the above student had any of the following symptoms in the past 24 hours? (Check all that apply)
*
Cough
Shortness of breath or difficulty breathing
Chills
Repeated shaking with chills
Muscle pain
Headache
Sore throat
Loss of taste or smell
Diarrhea
Feeling feverish or a measured temperature greater than or equal to 100.0 degrees Fahrenheit
No Symptoms
Required
Has the above student had known close contact with a person who is lab-confirmed with COVID-19 over the past 2 weeks?
*
Yes
No
Has a family member living with the above student had close contact with a person who is lab-confirmed with COVID-19 over the past 2 weeks?
*
Yes
No
If you have checked a symptom or answered yes to any question, the above listed student should not report to practice/rehearsal today.
Your answer
Send me a copy of my responses.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
Privacy
Terms
This form was created inside of Ann Arbor Public Schools.
Report Abuse
Forms
