NYSSRA Weekend - Feb 6-7 Pre-Event Health Screening
Complete this form PRIOR to travelling to race destination
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Last Name *
First Name *
Gender *
Email Address *
Mobile Phone Number *
Team/Club *
Primary Role *
Have you experienced any COVID-19 symptoms in the last 24 hours - including but not limited to fever, chills, cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, headache, new loss of taste or smell, sore throat, congestion or runny nose, nausea or vomiting, diarrhea? *
Have you had contact with persons diagnosed with COVID 19, or displaying COVID-19 symptoms, in the past 10 days? *
Have you traveled to and/or from outside of New York State to/from a non-contiguous state in the last 10 days? Non-contiguous is defined as any state other than VT, CT, MA, NJ, PA or another country. *
If you answered YES to the previous question, have you completed the 10 day quarantine, or tested out of the 10 day quarantine with 2 negative tests? For more information on testing out of quarantine, visit the NY Forward Website: https://coronavirus.health.ny.gov/covid-19-travel-advisory *
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