Participant Screening for Behind the Wheel Lessons - Under 18


 

May 5, 2021

Student’s Name:   

 

Please Answer the following questions prior to each lesson:

  • Do you have any symptoms associated with COVID - 19?  
  • Have you tested positive for COVID - 19?     
  • Have you been in close contact with anyone that has tested positive or exhibited symptoms from COVID - 19 in the last 14 days?    
  • Temperature at the start of the lesson:    

 

**A yes answer to any of the questions or a temperature of 100 or more will not be allowed to participate.

 

I understand the health risks associated with participating in this driving lesson due to COVID - 19 and I give permission for my child  to participate.

Leave this empty:

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Signature Certificate
Document name: Participant Screening for Behind the Wheel Lessons - Under 18
lock iconUnique Document ID: 3e5549902a6ac16a972881114729137cf5e73bd4
Timestamp Audit
October 2, 2020 3:30 pm EDTParticipant Screening for Behind the Wheel Lessons - Under 18 Uploaded by Premier Driving School, Inc - service@premierdriversed.com IP 100.16.21.95
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