KLB PARENT Wellness Survey
To be completed by the parent that will be accompanying their skater AT LEAST 2 hours before the start of each practice.
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Parent's First Name *
Parent's Last Name *
Date of practice (Example, June = 6) *
MM
/
DD
Is the participant experiencing any of the following symptoms; fever, chills, cough, shortness of breath, sore throat, stuffy/runny nose, loss of sense of smell, headache, fatigue, diarrhea, nausea or vomiting? *
Has the participant been potentially exposed to the COVID-19 virus (been advised that somebody they have been in close contact has been asked to self-isolate)? *
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