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Covid-19 Screening Form
Do you have any of the following symptoms today?
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* Indicates required question
Email
*
Your email
Fever of 100.4 F or above
*
Yes
No
Cough (new, undiagnosed cough)
*
Yes
No
Trouble breathing or shortness of breath
*
Yes
No
Sore Throat
*
Yes
No
Sudden Change in taste or smell
*
Yes
No
Muscle aches or pains
*
Yes
No
Student Name
*
Your answer
I understand that by submitting this form I am digitally signing that I am free from these symptoms. I will wash my hands and bring my own water to practice.
*
Yes
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