To be completed by parent/guardian or player age 16 & over, prior to each in-person rehearsal. "*" indicates required fields Your name* First Last Your child's name* First Last Member of which orchestra?* Junior Intermediate Senior Contact Phone Number*Has you/your child been advised to isolate at home because a family member tested positive? Answer NO if your vaccinated child has no symptoms and their Rapid Antigen Test is negative.* Yes No Do you or your child have any of the following symptoms?fever** Fever and/or chills. Temperature of 37.8 degrees Celsius/100 degrees Fahrenheit or higher and/or chills Yes No cough** Cough or barking cough (croup). Continuous, more than usual, making a whistling noise when breathing (not related to asthma, post-infectious reactive airways, or other known causes or conditions they already have). Yes No Short breath** Shortness of breath. Out of breath, unable to breathe deeply (not related to asthma or other known causes or conditions they already have). Yes No decrease** Decrease or loss of taste or smell. Not related to seasonal allergies, neurological disorders, or other known causes or conditions they already have. Yes No nausea** Nausea, vomiting and/or diarrhea. Not related to irritable bowel syndrome, anxiety, menstrual cramps, or other known causes or conditions they already have. Yes No throat** Sore throat or difficulty swallowing. Painful swallowing not related to seasonal allergies, acid reflux, or other known causes conditions they already have. Yes No runny nose** Runny or stuffy/congested nose. Not related to seasonal allergies, being outside in cold weather, or other known causes conditions they already have. Yes No headache** Headache. Unusual, long-lasting (not related to tension-type headaches, chronic migraines, or other known causes conditions they already have. Yes No tired** Extreme tiredness. Unusual fatigue, lack of energy, (not related to depression, insomnia, thyroid disfunction, sudden injury, or other known causes conditions they already have). Yes No muscle ache** Muscle aches or joint pain. Other than directly related to receiving vaccines. Yes No Because you answered YES to any of the above questions*please don't attend the upcoming rehearsal. We will be notified automatically that you are not attending; no need to send us a separate message. I agree
