RCS COVID-19 Health Survey - 8th Grade Basketball

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Please contact the head coach if you've answered yes to any questions.

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Last Name *

First Name *

Enter today's date *

ДД

ММ

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Choose your grade *

Parent Name *

Parent Phone Number *

Do you have any of the following symptoms of COVID-19: Fever, Chills, Cough, Shortness of Breath, Difficulty Breathing, Fatigue, Muscle or Body Aches, Headache, New loss of taste or smell, Sore Throat, Congestion or Runny Nose, Rash, Nausea or Vomiting, Diarrhea? * *

Yes

Have you had close contact with or cared for someone with COVID-19? (within the past 14 days) Close contact is defined as: Being within 6 feet of said person for at least 15 minutes, providing care at home to said person, direct physical contact with infected person (touched, hugged, kissed), sharing eating or drinking utensils, infected person sneezed, coughed or somehow got respiratory droplets on you. * *

Yes

Have you traveled outside of the United States within the past 14 days? * *

Yes

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