Soccer Camp COVID-19 Health Screening

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Participants, coaches, staff and officials should stay home if they present any viral symptoms. A health screening will be conducted upon arrival of all staff, participants and volunteers. This information will be maintained by the Totowa PAL as a private medical record.

Today's Date *

YYYY

Player First & Last Name *

Have you been in close contact with a confirmed case of COVID-19 in the past 14 days OR have you been asked to quarantine in the last 14 days? *

Yes

Are you experiencing a cough, shortness of breath or sore throat? *

Yes

Have you had a fever in the last 48 hours? *

Yes

Have you had a loss of taste or smell? *

Yes

Do you have abdominal pain, nausea, vomiting or diarrhea? *

Yes

Do you have a fever at or above 100.3 degrees Fahrenheit? *

Yes

If yes, what is your temperature (in deg Fahrenheit)?

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