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    (This is just for review. A copy of the questionnaire will be provided to guests at the venue)

    Commencement Ceremony Admission Questionnaire

    The questionnaire below must be completed in order to be admitted into any Duval County Public School 2020 commencement ceremony. 

                                                

    1. Have you or any member of your household tested positive for COVID-19 within the past fourteen (14) days?

    □ Yes               □ No

     

    1. Have you or any member of your household had close contact with someone who was diagnosed with COVID-19 or is under investigation for COVID-19 within the last fourteen (14) days?

    □ Yes               □ No

     

    1. Have you or any member of your household returned from any international travel or a cruise?

    □ Yes               □ No

     

    1. Do you currently have any of the symptoms below that may be due to COVID-19 (check all that apply)?

     

    □ Fever or chills

    □ Cough

    □ Shortness of breath or difficulty breathing

    □ Fatigue

    □ Sore throat

    □ Muscle or body aches

    □ Headache

    □ New loss of taste or smell

    □ Congestion or runny nose

    □ Nausea or vomiting

    □ Diarrhea

     

     

     

    Signature:  ____________________________________________       Date:  ______________

     

     

    Name (Print): _________________________________________________________________

     

     

    Phone Number:  ______________________________________________________________

     

     

    Email:  _____________________________________________________________________