Shen Lacrosse COVID-19 Health Assessment

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This assessment must be completed each day before arriving at practice. You will be asked to present the confirmation email you receive.

Email *

Player First & Last Name *

Practice Date *

You must fill out this form within 24 hours of EVERY practice date

YYYY

Experienced COVID-19 Symptoms in the past 14 Days? *

Yes

Positive COVID-19 Test in the past 14 days? *

Yes

Close contact with confirmed or suspected COVID-19 case in past 14 days? *

Yes

Have you traveled out of the area in the last 14 days? *

Yes

Is your temperature symptomatic (100.4º F or higher?) *

Yes

Parent Phone *

Parent First & Last Name *

Your name constitutes your electronic signature. By signing, you are affirming this mandatory health screening assessment and have reviewed & acknowledged the Healthy & Safety Guidelines, and agree to the following guidlines.

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