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KLB Athlete Wellness Survey
To be completed by the skater or their legal guardian AT LEAST 2 hours before the start of each practice. Failure to complete the survey will result in the skater not being eligible to participate in the practice.
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* Indicates required question
Skater's First Name
*
Your answer
Skater's Last Name
*
Your answer
Date of practice (Example, June = 6)
*
MM
/
DD
Is the participant experiencing any of the following symptoms; fever, chills, cough, shortness of breath, sore throat, stuffy/runny nose, loss of sense of smell, headache, fatigue, diarrhea, nausea or vomiting?
*
Yes
No
Has the participant been potentially exposed to the COVID-19 virus (been advised that somebody they have been in close contact has been asked to self-isolate)?
*
Yes
No
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