This form MUST be filled out and turned in each day a student is training in person. You may turn this form in either electronically (preferred) or at the location by adult student or legal guardian. Forms may not be submitted a day(s) in advance, as we need to assess health daily.
If filling this out electronically, please submit prior to 12:00 pm so we can print the list and have it with us at the training location.
Symptom Check List
People with COVID-19 have had a wide range of symptoms reported – ranging from mild symptoms to severe illness.
If you answer “yes” to any of these symptoms, do NOT come to class today. Symptoms may appear 2-14 days after exposure to the virus. People with these symptoms may have COVID-19:
This list does not include all possible symptoms. The CDC will continue to update this list as we learn more about COVID-19.
By signing this form, you verify that you or your child has not shown any of the above symptoms.
Additionally, I understand by signing this form that I will not hold Original Okinawan Karate of Holt, or any of its employees or volunteers liable or responsible for any viral, germ, bacteria or infectious disease I may contract, including covid-19.
Event Date: October 5th, 2021