Return to Play - Daily Participation Questionnaire

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This form must be completed prior to arrival on campus by a parent/guardian of each student-athlete each day

Name of Athlete

Both my athlete and I have read and agree to adhere to all Holy Family High School Summer Workout Guidelines

Yes

Clear selection

Does the athlete have a fever of 100.4 or higher?

Yes

Clear selection

Does the athlete have a dry cough?

Yes

Clear selection

Does the athlete have shortness of breath?

Yes

Clear selection

Does the athlete have a sore throat?

Yes

Clear selection

Does the athlete have a head ache, body aches, or chills?

Yes

Clear selection

Does the athlete have vomiting, diarrhea, or nausea?

Yes

Clear selection

Does the athlete have loss of taste or smell?

Yes

Clear selection

Does the athlete have a runny nose?

Yes

Clear selection

HFHS requires anyone: (i) who is a member of a vulnerable population; (ii) who is sick; (iii) who has tested positive for COVID-19; (iv) who is awaiting COVID-19 test results; (v) who has symptoms of COVID-19; or (vi) who has, within 14 days of scheduled RETURN TO PLAY programming, had close contact with a person with COVID-19 . . . . . to stay home and not participate at present. Does the athlete meet any of the aforementioned criteria?

Yes

Clear selection

Electronic Signature - everything included in the Form is accurate to the best on my knowledge.

Submit

Clear form

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