Covid Self Screening

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CSC Summer Invite

Email *

First Name of Swimmer/ Coach/ Volunteer/ Official *

Last Name *

Phone Number *

Have you or someone in your household tested positive for COVID-19 within the last 14 days? *

Yes

Have you experienced new or worsening, fever, chills, cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, headache, loss of taste or smell, sore throat, congestion or runny nose, nausea or vomiting, diarrhea in the past 48 hours? *

Yes

Club Name *

I have answered the screening questions to the best of my knowledge. Entering my name below is to be accepted as a signature. Please print and bring a copy with you to the meet *

Signature

Please print and bring a copy with you to the meet

or you may show the email confirmation you will receive on your phone

A copy of your responses will be emailed to the address you provided.

Submit

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