Lady Lions 03 Girls COVID-19 Health Assessment Form: Training Sessions

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Please submit all this information within 24 hours of your training session. We need the help of all our community to ensure we are able to enjoy the game we love. Thank you for all your help as we navigate these unpredictable circumstances.

The safety of our community is our overriding priority. As the coronavirus (COVID-19) pandemic continues, we are monitoring the situation closely and following the guidance from the Centers for Disease Control and Prevention and local health authorities. In order to prevent the spread of the coronavirus and reduce the potential risk of exposure to our members, we are asking everyone to complete and submit this questionnaire prior to entering the fields. If you answer 'Yes' to any of the questions, please stay home till you are symptom free or until you can answer 'No' to all questions.

Thank you and stay safe, Lions Futball Club

Players Full Name *

Team *

Lady Lions 03 Red- Coach Michael Yates

Have you had any signs or symptoms of a fever in the past 24 hours such as chills, sweats, felt "feverish" or had a temperature that is elevated for you/100.4 F or greater? *

Yes

Do you have any of the following symptoms? Cough, Shortness of Breath or Chest Tightness, Sore Throat, Nasal Congestion/Runny Nose, Myalgia (Body Aches), Loss of Taste and/or Smell, Diarrhea, Nausea, Vomiting, Fever/Chills/Sweats *

Yes

In the past 14 days, have you been in close proximity to anyone who was experiencing any of the above symptoms or has experienced any of the above symptoms since your contact?(Close proximity is defined as being 6 feet or closer for more than 15 minutes or having direct contact with fluids from an individual (ex. being coughed or sneezed on) *

Yes

Have you traveled internationally or outside of state in the last 14 days? *

Yes

Have you had any close contact in the last 14 days with someone with a diagnosis of COVID-19?(Close proximity is defined as being 6 feet or closer for more than 15 minutes or having direct contact with fluids from an individual (ex. being coughed or sneezed on) *

Yes

Have you been tested for COVID-19 and are waiting to receive test results? *

Yes

Have you tested positive for COVID-19, or are you presumptively positive for COVID-19 based on your health care provider’s assessment of your symptoms? *

Yes

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