Cicero Little League COVID-19 Questionaire

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

In compliance with NYS guidelines, all participants MUST complete this form in good faith prior to any Cicero Little Little league events such as practices or games.

Email *

Parent / Guardian Name *

Player's Name (s) *

Player's Division *

Team manager's last name? *

Have you or anyone in your household had COVID-19 symptoms in the past 14 days, including but not limited to cough, shortness of breath or difficulty breathing, fever, chills, muscle pain, sore throat, or loss of taste or smell? *

Yes

Have you or anyone in your household had a positive COVID-19 test in the past 14 days? *

Yes

Are you or is anyone in your household awaiting the results of a COVID-19 test? *

Yes

Have you or anyone in your household had close contact with a person who is considered a confirmed or suspected positive COVID-19 case in the past 14 days? *

Yes

Have you or anyone in your household traveled outside of New York State to a state designated as a state with significant community spread of Covid-19 pursuant to the New York State Travel Advisory? *

Yes

Have you or anyone in your household had contact with an individual who resides in or traveled outside of New York State to a state designated as a state with significant community spread of Covid-19 pursuant to the New York State Travel Advisory? *

Yes

Send me a copy of my responses.

Submit

Clear form

Never submit passwords through Google Forms.

reCAPTCHA

Privacy Terms

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms