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Pre-Meet Covid Health Form-Coves July 16th meet
This form is required to volunteer at our meet Thursday July 16th
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* Indicates required question
Email Address
*
Your answer
Volunteer first and last name (one form filled out per volunteer please)
*
Your answer
Have you had any signs of a cough, fever, or difficulty breathing within the past 14 days? *
*
Yes
No
Have you been in close contact (6 feet for 10 minutes or more) with anyone with a confirmed diagnosis of COVID-19, a PUI (a person under investigation for COVID-19), or with anyone with severe respiratory symptoms requiring hospitalization? *
*
Yes
No
Other:
Within the past 14 days, have you traveled to a CDC level 2 or 3 area? (Current listings available at
https://wwwnc.cdc.gov/travel
) *
*
Yes
No
If you answered yes to the above question, please list the location.
Your answer
Swimmer first and last name
*
Your answer
Swimmer Age Group
*
8U
9/10
11/12
13/14
15U
Other:
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