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COVID-19 Athlete/Coach Health Monitoring Form
Lansing Eastern High School
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* Indicates required question
Name: (Please add your first and last name)
*
Your answer
Phone Number
*
Your answer
Emergency Contacts Name:
*
Your answer
Emergency Contacts Phone Number:
*
Your answer
Fall/Winter/Spring sport workout you are participating in?
*
Baseball
Girls Soccer
Softball
Girls Tennis
Track & Field
Girls Basketball
Boys Basketball
Bowling
Wrestling
Boys Soccer
Football
Volleyball
Boys Tennis
Cross Country
Other:
Subjective fever (felt feverish)
*
YES
NO
New or worsening cough?
*
YES
NO
Sore throat?
*
YES
NO
Shortness of breath?
*
YES
NO
Close contact, or cared for someone with covid-19?
*
YES
NO
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