Pre-Activity Form
Please take a moment to fill out this health questionnaire the day of your practice, preferably 1 hour before practice each day.  Please be sure to answer these honestly.  Our #1 concern is the health of you and your teammates.  Missing a few practices is minimal to potentially infecting teammates and their families.  We appreciate it!

Please be sure to bring your own MASK, LABELED WATER BOTTLE,  HAND SANITIZER and OTHER EQUIPMENT.  Items MAY NOT be shared among athletes for your safety.  

Athletes MUST maintain a minimum distance of 10 feet between each other at all times.

If you answer Yes to any questions please do not go to practice or report to school.


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Sport *
Full first name and last name *
Emergency contact *
Emergency phone number *
A new fever (100.4°F or higher) or a sense of having a fever? *
A new cough that you cannot attribute to another health condition? *
New shortness of breath that you cannot attribute to another health condition? *
A new sore throat that you cannot attribute to another health condition? *
New muscle aches (myalgia) that you cannot attribute to another health condition or that may have been caused by a specific activity (such as physical exercise)? *
A new onset of loss of sense of taste or smell? *
Nausea or Vomiting *
Diarrhea? *
Congestion or runny nose? *
Have you been around someone who is sick? *
Been exposed to someone who is sick or diagnosed with Covid-19 within the last 14 days *
Have you been around someone who has symptoms of illness or someone who has tested positive for COVID-19? *
Been informed by a health care provider or public health authority to self-isolate or self-quarantine for a period of time that has not yet expired *
Taken fever reducing medication in the last 24 hours to reduce temperature *
I acknowledge that I have answered these questions to the best of my ability.  I understand that if I show signs or symptoms of potential respiratory illness, or if I have a fever that I will be required to return home and may not stay on LCPS campus. *
Chris Campbell
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