Athletics Department Daily Attendance and COVID-19 Daily Screening Questions

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

This form must be completed daily by Student Athletes before each Athletic Department Activity in order for a Student Athlete to be allowed to participate in Athletic Department Activities.

Email *

Students Full Name *

Date *

YYYY

Your Reason for Attending Athletics Today *

Practice

Game

Open Gym / Weight Room Workout

Summer Workouts

Parent/Guardian Cell Phone Number *

Are you experiencing any of the following symptoms? Check All that Apply. If you are not experiencing any of the following symptoms please check NONE. *

Fever (≥ 100.4°F)

Cough or shortness of breath

Sore Throat

Chills

Muscle aches or rigors

Headache

New loss of taste or smell

Abdominal pain, nausea, vomiting or diarrhea

NONE

Required

Have you had close contact with someone who is currently sick? *

YES

Have you been diagnosed with COVID-19 in the past three weeks or have reason to believe you have COVID-19? *

Yes

Have you traveled or had close contact with anyone who has traveled internationally in the last 14 days? *

Yes

When you took your temperature this morning before you arrived at school, what was the reading? *

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

Submit

Clear form

Never submit passwords through Google Forms.

reCAPTCHA

Privacy Terms

This form was created inside of Trenton Catholic Academy. Report Abuse

Forms