Permian Girls Gymnastics Symptom Check Fall 2020

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Please Fill Out Form ENTIRELY and HONESTLY

What is your First and Last Name? *

What is Your School ID Number *

Have you been around anyone who has been diagnosed with COVID-19 or is/has experienced symptoms of COVID-19 in the past two weeks? *

Yes

Have you been diagnosed with COVID-19 in the past two weeks? *

Yes

Do you have any of the Following symptoms? (Cough, Shortness of Breath/Difficulty Breathing, Chills, Repeated Shaking with Chills, Muscle Aches/Pain, Feeling Feverish or Temperature over 100.0° F, Chest Pain, Diarrhea, Loss of Taste or Smell, Sore Throat, Headache) *

Yes

I _____________ agree that the above information is current and true to the best of my knowledge. TYPE YOUR FIRST AND LAST NAME *

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