2020 COVID-19 QUESTIONNAIRE | Sterling High School

YOU MUST FILL OUT THIS QUESTIONNAIRE A MINIMUM OF 7 DAYS BEFORE PRACTICING WITH YOUR TEAM THIS SUMMER.

Student First Name: *

Student Last Name: *

Date: *

Month

Day

Year

Parent/Guardian Name: *

Parent/Guardian Cell No.: *

HAS YOUR SON/DAUGHTER BEEN DIAGNOSED WITH COVID-19?: *

Yes

IF DIAGNOSED WITH CORONAVIRUS (COVID-19), WAS YOUR SON/DAUGTHER SYMPTOMATIC?:

Yes

IF DIAGNOSED WITH CORONAVIRUS (COVID-19), WAS YOUR SON/DAUGHTER HOSPITALIZED?:

Yes

HAS ANY MEMBER OF THE STUDENT ATHLETE'S HOUSEHOLD BEEN DIAGNOSED WITH CORONAVIRUS (COVID-19)?: *

Yes

Parent/Guardian Electronic Signature: *

**To participate in workouts during the summer recess period, the parent/guardian must complete this form. This form only needs to be completed one time **

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