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CA/SCMW- Covid Symptoms Screenings
Please complete prior to each visit to CA
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* Indicates required question
Athlete Name
*
Your answer
Parent Name
*
Your answer
Telephone Number
*
Your answer
Has the athlete suffered from a fever in the last 10 days?
*
Yes
No
Required
Did you take the athlete's temperature prior to coming to CA?
*
Yes
No
Required
Does the athlete have a temperature higher than 99.8 degrees?
*
Yes
No
Required
Is the athlete experiencing resperatory distress or a dry cough, cold/flu-like symptoms, or gastrointestinal sympotoms?
*
Yes
No
Required
Has the athlete tested positive for COVID-19, or been in contact with anyone who was positive for COVID-19 in the last 10 days?
*
Yes
No
Required
I agree to wear a mask during my time at CA and adhere to safety protocols put in place.
Yes
No
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