Chatham HS COVID-19 (one time) - Winter 2020-2021 Pre-Participation Questionnaire

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To participate in Chatham HS Winter Athletics, the parent/guardian must complete this form.

Email *

Parent Last Name

Parent First Name

Parent/Guardian Cell Number *

Student Last Name *

Student First Name *

Grade *

Today's Date *

YYYY

Sport - Choose One *

1. Has your son/daughter been diagnosed with Coronavirus (COVID-19)? *

Yes

1 A. If diagnosed with Coronavirus (COVID-19), was your son/daughter symptomatic? *

Yes

Not diagnosed with COVID-19

1 B. If diagnosed with Coronavirus (COVID-19), was your son/daughter hospitalized? *

Yes

Not diagnosed with COVI-19

2. Has any member of the student-athlete’s household been diagnosed with Coronavirus (COVID-19)? *

Yes

3. Parents/guardians of student-athletes who have pre-existing medical conditions and/or are immunocompromised (e.g., diabetes, asthma, auto-immune disorders, etc.) should consult with their family physician and strongly consider obtaining a physician's clearance prior to permitting their child’s participation in athletic activities. *

As the parent/guardian I have read the statement above pertaining to medical guidance.

Required

4. I as the parent/guardian attest that the responses on this form are accurate and submission of the form constitutes agreement with all Chatham High School protocols for participation in athletic activities. *

As the parent/guardian I agree to abide by all Chatham High School regulations related to COVID-19.

Required

Send me a copy of my responses.

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