Throop Little League Screening Form-Kalinoski Law

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ALL Parents/Legal Guardians must answer a series of COVID-related sign and symptom screening questions regarding the participant and attest to their good health. This also applies for all coaches.

* Submissions must be completed 2-4 hours prior to all games and practices
* All submissions will be automatically time and date-stamped through Google for record-keeping.
* Any Athletic Participant or Coach that reports experiencing symptoms or reports a body temperature of 100.4 degrees or above will be prohibited from that day's activity and instructed to follow up with their primary care physician.
* The Athletic Participant or Coach will require physician clearance in order to return to activity.

Email *

Name of Parent or Legal Guardian *

Name of Player or Coach *

Has your child had any of these symptoms within the last 72 hours? *

Yes

Fever of 100.4 or above

Body Chills

Muscle or body aches

Extreme Fatigue

Cough

Shortness of breath or difficulty breathing

Headache

Sore Throat

Congestion or runny nose

Loss of Taste or Smell

Abdominal pain or diarrhea

Nausea or Vomiting

What was the player's or coach's temperature as of today? *

Has your child traveled or had close contact with anyone who has traveled out of the state or country in the last 14 days? *

Yes

Has your child had any direct contact with someone that has a suspected or lab confirmed case of COVID-19? *

Yes

Has your child been diagnosed with COVID-19 in the past three weeks or have reason to believe your child has COVID-19? *

Yes

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

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