COVID Symptoms Questionnaire

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In order to keep you and your family safe, please fill out this survey prior to any tournaments or meets.

Name of Athlete *

Have you had close contact with someone diagnosed with COVID-19 in the past 5 days? *

Yes

Have you experienced a fever in the past 5 days? *

Yes

Have you had a cough in the past 5 days? *

Yes

Have you had any respiratory illness or difficulty in breathing in the past 5 days? *

Yes

Have you had any loss of smell or taste in the past 5 days? *

Yes

Have you been fully vaccinated? *

Yes

I agree to follow the protocols listed below to ensure the health, safety and welfare of my family members as well as my teammates: *

Wear masks at all times when it is not possible to social distance. I will not drink from any other players water bottle or drinks. I will wash my hands before and after each game.

I agree

Name of Parent/Guardian *

Email of Parent/Guardian *

Date *

YYYY

Submit

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