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Regional Husky VB Health Self Report
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* Indicates required question
Your Name
*
Your answer
Your grade last spring
*
Middle School
9th Grade
10th Grade
11th Grade
12th Grade
Coach
Your Court Today
*
Court 1
Court 2
Court 5
Court 6
Other:
Do You Have Any of the Following? (if so, notify a Husky staff member before entering)
*
Fever, Shortness of breath or difficulty breathing, Cough, Chills, Headache, Sore Throat, recent loss of taste or smell?
In the past 14 days have you been in Alabama, Arkansas, Arizona, California, Florida, Georgia, Iowa, Idaho, Louisiana, Mississippi, North Carolina, Nevada, South Carolina, Tennessee, Texas or Utah
None of the above, Feel good and haven't been in those states in the last 14 days
Other:
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